U.S. patent application number 09/819924 was filed with the patent office on 2001-11-22 for in vivo delivery methods and compositions.
Invention is credited to Kensey, Kenneth R..
Application Number | 20010044584 09/819924 |
Document ID | / |
Family ID | 27559992 |
Filed Date | 2001-11-22 |
United States Patent
Application |
20010044584 |
Kind Code |
A1 |
Kensey, Kenneth R. |
November 22, 2001 |
In vivo delivery methods and compositions
Abstract
Various methods are provided for determining and utilizing the
viscosity of the circulating blood of a living being over a range
of shear rates for diagnostics and treatment, such as
detecting/reducing blood viscosity, work of the heart,
contractility of the heart, for detecting/reducing the surface
tension of the blood, for detecting plasma viscosity, for
explaining/countering endothelial cell dysfunction, for providing
high and low blood vessel wall shear stress data, red blood cell
deformability data, lubricity of blood, and for treating different
ailments such as peripheral arterial disease in combination with
administering to a living being at least one pharmaceutically
acceptable agent. Agents pharmaceutically effective to regulate at
least one of the aforementioned blood parameters are used to adjust
distribution of a substance through the bloodstream.
Inventors: |
Kensey, Kenneth R.;
(Malvern, PA) |
Correspondence
Address: |
CAESAR, RIVISE, BERNSTEIN,
COHEN & POKOTILOW, LTD.
12TH FLOOR, SEVEN PENN CENTER
1635 MARKET STREET
PHILADELPHIA
PA
19103-2212
US
|
Family ID: |
27559992 |
Appl. No.: |
09/819924 |
Filed: |
March 28, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09819924 |
Mar 28, 2001 |
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09727950 |
Dec 1, 2000 |
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09727950 |
Dec 1, 2000 |
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09628401 |
Aug 1, 2000 |
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09628401 |
Aug 1, 2000 |
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09501856 |
Feb 10, 2000 |
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09501856 |
Feb 10, 2000 |
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09439795 |
Nov 12, 1999 |
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09439795 |
Nov 12, 1999 |
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08919906 |
Aug 28, 1997 |
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6019735 |
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Current U.S.
Class: |
600/504 ;
600/573; 604/66; 604/67 |
Current CPC
Class: |
A61M 2230/04 20130101;
A61B 5/15003 20130101; A61B 5/150992 20130101; A61K 47/6957
20170801; A61M 1/3672 20130101; A61K 49/0004 20130101; A61B 5/155
20130101; A61B 5/021 20130101; G01N 11/06 20130101; A61B 5/7278
20130101; G01N 11/04 20130101; A61B 5/029 20130101; G01N 11/00
20130101; A61B 5/14557 20130101; A61M 1/361 20140204; A61B 5/6866
20130101; A61B 5/02035 20130101; A61B 5/0215 20130101; A61B 5/02028
20130101 |
Class at
Publication: |
600/504 ;
600/573; 604/66; 604/67 |
International
Class: |
A61B 005/00 |
Claims
1. A method to distribute a substance through a bloodstream of an
organism, said method comprising: monitoring at least one blood
flow parameter of said bloodstream, said at least one blood flow
parameter being selected from the group consisting of circulating
blood viscosity, absolute viscosity, effective viscosity, low shear
viscosity, high shear viscosity, shear rate of circulating blood,
work of heart, contractility of heart, thrombogenicity, platelet
aggregation, lubricity, red blood cell deformability, thixotropy,
yield stress, coagulability, coagulation time, agglutination, clot
retraction, clot lysis time, sedimentation rate and prothrombin
rate; administering said substance to said organism such that an
amount of said substance enters said bloodstream; and distributing
at least a portion of said amount of said substance to at least one
target within said organism, wherein a distribution parameter of
said distributing is adjusted by altering said at least one blood
flow parameter.
2. The method of claim 1, wherein said substance is a
pharmaceutically active agent.
3. The method of claim 1, wherein said organism is a human.
4. The method of claim 1, wherein said administering is
enteral.
5. The method of claim 1, wherein said administering is
parenteral.
6. The method of claim 5, wherein said administering is through
intravenous injection, subcutaneous injection, intramuscular
injection, inhalation or percutaneous application.
7. The method of claim 1, wherein said amount of said substance is
about 1 wt. % to about 100 wt. % of a total amount of said
substance administered to said organism.
8. The method of claim 1, wherein said portion is about 1 wt. % to
about 100 wt. % of said amount.
9. The method of claim 1, wherein said at least one target is a
cell, tissue organ or system.
10. The method of claim 1, wherein said distribution parameter is a
rate of said distributing.
11. The method of claim 9, wherein said rate of said distributing
is increased.
12. The method of claim 9, wherein said rate of said distributing
is decreased.
13. The method of claim 9, wherein said rate of said distributing
is decreased and said substance is a psychoactive ingredient of an
addictive product.
14. The method of claim 9, wherein said rate of said distributing
is decreased and said substance is an ingredient of a tobacco
product.
15. The method of claim 1, wherein said altering comprises
delivering to said bloodstream an agent effective to alter said at
least one blood flow parameter.
16. The method of claim 1, wherein said agent is at least one
member selected from the group consisting of levonorgestrel,
estrogen, progestin, estradiol, ethinyl estradiol, ethynodiol,
medroxyprogesterone, desogestrel, cyproterone, norethindrone,
gestodene, norgestrel, mestranol, norgestimate, metformin,
acarbose, insulin, chlorpropamide, glipizide, glyburide,
tolazamide, glimepiride, troglitazone, proglitazone, repaglinide,
losartan potassium, candesartan cilexetil, irbesartan, mitiglinide,
trendolapril/verapamil, nateglinide, nifedipine, nisoldipine,
nicardipine, bepridil, isradipine, nimodipine, felodipine,
amlodipine, diltiazem, verapamil, isosorbide mononitrate,
isosorbide dinitrate, nitroglycerin, hydralazine, minoxidil,
hydrochlorothiazide, chlorothiazide, indapamide, metolazone,
furosemide, bumetanide, ethacrynic acid, torsemide, spironolactone,
triamterene, acetazolamide, mannitol, atenolol, bisoprolol,
pindolol, metoprolol, timolol, nadolol, propanolol, carvedilol,
captopril, fosinopril, benazepril, lisinopril, enalapril,
quinapril, losartan, valsartan, eprosartan, trandolapril,
fenoldopam, ramipril, doxazosin, milrinone, benidipine, lemakalim,
fantofarone, lemildipine, pirmenol, clentiazem, nebivolol,
oxodipine, sematilide, pranidipine, nifekalant, aranidipine,
barnidipine, lacidipine, bucindolol, azelnidipine, dofetilide,
ibutilide, watanidipine, lercanidipine, landiolol, telmisartan,
furnidipine, azimilide, CHF 1521, valsartan/hydrochlorothlazide,
enalapril/nitrondipine, sotalol, arbutamine, olmesartan,
conivaptan, lovastatin, atorvastatin, cerivastatin, simvastatin,
fluvastatin, cholestyramine, colestipol, clofibrate, gemfibrozil,
fenofibrate, pamaqueside, pitavastatin, phentermine,
phendimetrazine, sibutramine, orlistat, aspirin, warfarin,
enoxaparin, heparin, low molecular weight heparin, cilostazol,
clopidogrel, ticlopidine, tirofiban, abciximab, dipyridamole,
plasma protein fraction, human albumin, low molecular weight
dextran, hetastarch, reteplase, alteplase, streptokinase,
urokinase, dalteparin, filgrastin, immunoglogulin, ginkolide B,
hirudins, foropafant, rocepafant, bivalirudin, dermatan sulfate
mediolanum, eptilibatide, thrombomodulin, low molecular weight
dermatan sulfate-opocrin, eptacog alfa, argatroban, fondaparinux
sodium, tifacogin, lepirudin, desirudin, OP2000, melagatran,
roxifiban, parnaparin sodium, human hemoglobin (Hemosol), bovine
hemoglobin (Biopure), human hemoglobin (Northfield), antithrombin
III, RSR 13, heparin-oral (Emisphere) transgenic antithrombin III,
H37695, mesoglycan, CTC111, nicotine, buprorion, fasudil,
ziconotide, amino acid preparations, minerals, electrolytes,
vitamins, calcitriol, ticarcillin disodium, cefixime, meropenem,
cefprozil, levofloxacin, cefpodoxime proxetil, imipenem, cefuroxime
axetil, trovafloxacin, mupirocin, stavudine, didanosine,
nevirapine, lamivudine, zidovudine, valcyclovir, ganciclovir,
nefiracetam, remifentanil, sevoflurane, tiagabine, topiramate,
lamotrigine, naratriptan, bromocriptine, tolcapone, oxaprozin,
diclofenac, misoprostol, nabumetone, granisetron, dotarizine,
RSR13, zonisamide, BMS204352, oxcarbazepine, tropisetron,
irinotecan, topetecan, anastrozole, nilutamide, cladribine,
gemcitabine, letrozole, vinorelbine, epirubicin, raloxifene,
calcitonin, somatotropin, recombinant somatropin, tolterodine,
temiverine, meluadrine tartrate, lansoprazole, ropivacaine,
bambuterol, israpafant, rupatadine, levosalbutamol, ARC68397AA,
salbutamol (powder), salbutamol (inhalation), salbutamol (oral),
salbutamol (powder inhilation), formoterol, salmeterol/fluticasone
propionate, salmeterol MDI dose counter, salmeterol (inhilation),
salmeterol hydrofluoroalkane, budesonide/formoterol, olopatadine,
levobetaxolol, levobunolol, latanoprost/timolol, ketotifen,
desferoxamine, leukine, sargramostin and GM-CSF.
17. The method of claim 15, wherein said blood flow parameter is
blood viscosity and said agent is at least one member selected from
the group consisting of intravenous diluents, red blood cell
deformability agents, antiurea agents, oral contraceptives,
anti-diabetic agents, antiarrythmics, antihypertensives,
antihyperlipidemics, antiplatelet agents, appetite suppressants,
antiobesity agents, blood modifiers, smoking deterrent agents, and
nutritional supplements.
18. The method of claim 15, wherein said blood flow parameter is
plasma viscosity and said agent is at least one member selected
from the group consisting of anti-diabetics, intravenous solutions,
cholesterol-lowering agents, triglyceride-lowering agents,
lubricants, homocysteine-reducing agents, and vitamin
supplements.
19. The method of claim 15, wherein said blood flow parameter is
work of the heart and said agent is at least one member selected
from the group consisting of beta-blockers, calcium channel
blockers, ACE inhibitors, ACE-II inhibitors, vasodilators, blood
pressure reducing agents, viscosity reducing agents and
anti-diabetic agents.
20. The method of claim 15, wherein said blood flow parameter is
low shear stress and said agent is at least one member selected
from the group consisting of beta blockers, calcium channel
blockers, ACE inhibitors, ACE-II inhibitors, vasodilators, blood
pressure reducing agents, viscosity reducing agents, contractility
reducing agents, anti-diabetics, and anti-obesity agents.
21. The method of claim 15, wherein said blood flow parameter is
high shear stress and said agent is at least one member selected
from the group consisting of intravenous solutions, anti-diabetics,
hemodilution agents, anti-platelet agents, lubricity enhancing
agents and adhesiveness minimizing agents.
22. The method of claim 15, wherein said blood flow parameter is
contractility of the heart and said agent is at least one member
selected from the group consisting of beta-blockers, calcium
channel blockers, and peripheral antiadrenergic/sympatholytics.
23. The method of claim 15, wherein said blood flow parameter is
thrombogenicity of the heart and said agent comprises at least one
anti-thrombogenic agent.
24. The method of claim 15, wherein said blood flow parameter is
platelet aggregation and said agent is at least one member selected
from the group consisting of warfarin, heparin, and anti-platelet
agents.
25. The method of claim 15, wherein said blood flow parameter is
lubricity and said agent is at least one member selected from the
group consisting of intravenous fluids, lubricants, anti-adhesives,
surfactants, and saponifying agents.
26. The method of claim 15, wherein said blood flow parameter is
thixotropy and said agent is at least one member selected from the
group consisting of sodium bentonite magma, colloidal clays,
colloidal silicon dioxide, and microcrystalline cellulose.
27. The method of claim 15, wherein said blood flow parameter is
yield stress and said agent is at least one member selected from
the group consisting of gels of colloidal clays, such as sodium
bentonite, gels of organic polymers, such as gelatin, agar, pectin,
methylcellulose, and high-molecular-weight polyethylene glycol.
28. The method of claim 15, wherein said blood flow parameter is
endothelial shear injury and said agent is at least one member
selected from the group consisting of beta-blockers and viscosity
reducing agents.
29. The method of claim 15, wherein said blood flow parameter is
coagulability and said agent is at least one member selected from
the group consisting of anti-thrombogenics, anti-platelets,
heparin, and anti-coagulants.
30. The method of claim 15, wherein said blood flow parameter is
coagulation time and said agent is at least one member selected
from the group consisting of anti-thrombogenics and anti-platelets,
heparin, and anti-coagulants.
31. The method of claim 15, wherein said blood flow parameter is
agglutination and said agent is at least one member selected from
the group consisting of anti-platelets and anti-coagulants.
32. The method of claim 15, wherein said blood flow parameter is
clot retraction and said agent is at least one member selected from
the group consisting of anti-thrombogenics, anti-platelets and
anti-coagulants.
33. The method of claim 15, wherein said blood flow parameter is
clot lysis time and said agent is at least one member selected from
the group consisting of anti-thrombogenics, anti-platelets and
anti-coagulants.
34. The method of claim 15, wherein said blood flow parameter is
prothrombin rate and said agent is at least one member selected
from the group consisting of heparin, warfarin and
anti-coagulants.
35. In a method for distributing a substance through a circulatory
system to at least one target in an organism, the improvement
wherein at least one blood flow parameter selected from the group
consisting of circulating blood viscosity, absolute viscosity,
effective viscosity, low shear viscosity, high shear viscosity,
shear rate of circulating blood, work of heart, contractility of
heart, thrombogenicity, platelet aggregation, lubricity, red blood
cell deformability, thixotropy, yield stress, coagulability,
coagulation time, agglutination, clot retraction, clot lysis time,
sedimentation rate and prothrombin rate is monitored and altered to
control said distributing.
36. A composition for administration to an organism having a
circulatory system, said composition comprising: a pharmaceutically
active agent; and a distribution agent effective to increase or
decrease distribution of said pharmaceutically active agent through
said circulatory system by increasing or decreasing at least one
blood flow parameter selected from the group consisting of
circulating blood viscosity, absolute viscosity, effective
viscosity, low shear viscosity, high shear viscosity, shear rate of
circulating blood, work of heart, contractility of heart,
thrombogenicity, platelet aggregation, lubricity, red blood cell
deformability, thixotropy, yield stress, coagulability, coagulation
time, agglutination, clot retraction, clot lysis time,
sedimentation rate and prothrombin rate, wherein said distribution
agent is not a diluent.
Description
RELATED APPLICATIONS
[0001] This application is a Continuation-in-Part of co-pending
U.S. patent application Ser. No. 09/727,950, filed Dec. 1, 2000,
entitled METHODS AND COMPOSITIONS FOR ADJUSTING PHYSICAL PROPERTIES
OF CIRCULATING BLOOD, which in turn is a Continuation-in-Part of
co-pending U.S. patent application Ser. No. 09/628,401, filed Aug.
1, 2000, entitled APPARATUS & METHODS FOR COMPREHENSIVE BLOOD
ANALYSIS, INCLUDING WORK OF, AND CONTRACTILITY OF, HEART, AND
THERAPEUTIC APPLICATIONS AND COMPOSITIONS THEREOF, which in turn is
a Continuation-in-Part of Co-Pending Application Ser. No.
09/501,856, filed Feb. 10, 2000, which in turn is a
Continuation-in-Part of Co-Pending Application Ser. No. 09/439,795,
filed Nov. 12, 1999, entitled DUAL RISER/SINGLE CAPILLARY
VISCOMETER, which in turn is a Continuation-in-Part of Co-Pending
Application Ser. No. 08/919,906, filed Aug. 28, 1997 (now U.S. Pat.
No. 6,019,735, issued on Feb. 1, 2000), entitled VISCOSITY
MEASURING APPARATUS AND METHOD OF USE, all of which are assigned to
the same Assignee as the present invention and all of whose entire
disclosures are incorporated by reference herein.
BACKGROUND OF THE INVENTION
[0002] This invention relates generally to apparatus and methods
for determining and utilizing the viscosity of the circulating
blood of a living being for diagnostics and treatment, and more
particularly, apparatus and methods for detecting/reducing blood
viscosity, work of the heart, contractility of the heart, for
detecting/reducing the surface tension of the blood, for detecting
plasma viscosity, for explaining/countering endothelial cell
dysfunction, for providing high and low blood vessel wall shear
stress data, red blood cell deformability, lubricity of blood, and
for treating different ailments, such as peripheral arterial
disease.
[0003] The importance of determining the viscosity of blood is
well-known. Fibrogen, Viscosity and White Blood Cell Count Are
Major Risk Factors for Ischemic Heart Disease, by Yarnell et al.,
Circulation, Vol.83, No.3, March 1991; Postprandial Changes in
Plasma and Serum Viscosity and Plasma Lipids and Lipoproteins After
an Acute Test Meal, by Tangney, et al., American Journal for
Clinical Nutrition, 65:36-40,1997; Studies of Plasma Viscosity in
Primary Hyperlipoproteinaemia, by Leonhardt et al., Atherosclerosis
28,29-40, 1977; Effects of Lipoproteins on Plasma Viscosity, by
Seplowitz, et al., Atherosclerosis 38, 89-95, 1981; Hyperviscosity
Syndrome in a Hypercholesterolemic Patient with Primary Biliary
Cirrhosis, Rosenson, et al., Gastroenterology, Vol.98, No.5,1990;
Blood Viscosity and Risk of Cardiovascular Events:the Edinburgh
Artery Study, by Lowe et al., British Journal of Hematology, 96,
168-171, 1997; Blood Rheology Associated with Cardiovascular Risk
Factors and Chronic Cardiovascular Diseases: Results of an
Epidemiologic Cross-Sectional Study, by Koenig, et al., Angiology,
The Journal of Vascular Diseases, November 1988; Importance of
Blood Viscoelasticity in Arteriosclerosis, by Hell, et al.,
Angiology, The Journal of Vascular Diseases, June, 1989; Thermal
Method for Continuous Blood-Velocity Measurements in Large Blood
Vessels, and Cardiac-Output Determination, by Delanois, Medical and
Biological Engineering, Vol. 11, No. 2, March 1973; Fluid Mechanics
in Atherosclerosis, by Nerem, et al., Handbook of Bioengineering,
Chapter 21, 1985.
[0004] Much effort has been made to develop apparatus and methods
for determining the viscosity of blood. Theory and Design of
Disposable Clinical Blood Viscometer, by Litt et al., Biorheology,
25, 697-712, 1988; Automated Measurement of Plasma Viscosity by
Capillary Viscometer, by Cooke, et al., Journal of Clinical
Pathology 41, 1213-1216, 1988; A Novel Computerized
Viscometer/Rheometer by Jimenez and Kostic, Rev. Scientific
Instruments 65, Vol 1, January 1994; A New Instrument for the
Measurement of Plasma-Viscosity, by John Harkness, The Lancet, pp.
280-281, Aug. 10, 1963; Blood Viscosity and Raynaud's Disease, by
Pringle, et al., The Lancet, pp. 1086-1089, May 22,1965;
Measurement of Blood Viscosity Using a Conicylindrical Viscometer,
by Walker et al., Medical and Biological Engineering, pp. 551-557,
September 1976.
[0005] One reference, namely, The Goldman Algorithm Revisited:
Prospective Evaluation of a Computer-Derived Algorithm Versus
Unaided Physician Judgment in Suspected Acute Myocardial
Infarction, by Qamar, et al., Am Heart J 138(4):705-709, 1999,
discusses the use of the Goldman algorithm for providing an
indicator to acute myocardial infarction. The Goldman algorithm
basically utilizes facts from a patient's history, physical
examination and admission (emergency room) electrocardiogram to
provide an AMI indicator.
[0006] In addition, there are a number of patents relating to blood
viscosity measuring apparatus and methods. See for example, U.S.
Pat. No. 3,342,063 (Smythe et al.); U.S. Pat. No. 3,720,097 (Kron);
U.S. Pat. No. 3,999,538 (Philpot, Jr.); 4,083,363 (Philpot); U.S.
Pat. No. 4,149,405 (Ringrose); U.S. Pat. No. 4,165,632 (Weber, et.
al.); U.S. Pat. No. 4,517,830 (Gunn, deceased, et. al.); U.S. Pat.
No. 4,519,239 (Kiesewetter, et. al.); U.S. Pat. No. 4,554,821
(Kiesewetter, et. al.); U.S. Pat. No. 4,858,127 (Kron, et. al.);
U.S. Pat. No. 4,884,577 (Merrill); U.S. Pat. No. 4,947,678 (Hori et
al.); U.S. Pat. No. 5,181,415 (Esvan et al.); U.S. Pat. No.
5,257,529 (Taniguchi et al.); U.S. Pat. No. 5,271,398 (Schlain et
al.); and U.S. Pat. No. 5,447,440 (Davis, et. al.).
[0007] The Smythe '063 patent discloses an apparatus for measuring
the viscosity of a blood sample based on the pressure detected in a
conduit containing the blood sample. The Kron '097 patent discloses
a method and apparatus for determining the blood viscosity using a
flowmeter, a pressure source and a pressure transducer. The Philpot
'538 patent discloses a method of determining blood viscosity by
withdrawing blood from the vein at a constant pressure for a
predetermined time period and from the volume of blood withdrawn.
The Philpot '363 patent discloses an apparatus for determining
blood viscosity using a hollow needle, a means for withdrawing and
collecting blood from the vein via the hollow needle, a negative
pressure measuring device and a timing device. The Ringrose '405
patent discloses a method for measuring the viscosity of blood by
placing a sample of it on a support and directing a beam of light
through the sample and then detecting the reflected light while
vibrating the support at a given frequency and amplitude. The Weber
'632 patent discloses a method and apparatus for determining the
fluidity of blood by drawing the blood through a capillary tube
measuring cell into a reservoir and then returning the blood back
through the tube at a constant flow velocity and with the pressure
difference between the ends of the capillary tube being directly
related to the blood viscosity. The Gunn '830 patent discloses an
apparatus for determining blood viscosity that utilizes a
transparent hollow tube, a needle at one end, a plunger at the
other end for creating a vacuum to extract a predetermined amount
and an apertured weight member that is movable within the tube and
is movable by gravity at a rate that is a function of the viscosity
of the blood. The Kiesewetter '239 patent discloses an apparatus
for determining the flow shear stress of suspensions, principally
blood, using a measuring chamber comprised of a passage
configuration that simulates the natural microcirculation of
capillary passages in a being. The Kiesewetter '821 patent
discloses another apparatus for determining the viscosity of
fluids, particularly blood, that includes the use of two parallel
branches of a flow loop in combination with a flow rate measuring
device for measuring the flow in one of the branches for
determining the blood viscosity. The Kron '127 patent discloses an
apparatus and method for determining blood viscosity of a blood
sample over a wide range of shear rates. The Merrill '577 patent
discloses an apparatus and method for determining the blood
viscosity of a blood sample using a hollow column in fluid
communication with a chamber containing a porous bed and means for
measuring the blood flow rate within the column. The Hori '678
patent discloses a method for measurement of the viscosity change
in blood by disposing a temperature sensor in the blood flow and
stimulating the blood so as to cause a viscosity change. The Esvan
'415 patent discloses an apparatus that detects the change in
viscosity of a blood sample based on the relative slip of a drive
element and a driven element, which holds the blood sample, that
are rotated. The Taniguchi '529 patent discloses a method and
apparatus for determining the viscosity of liquids, e.g., a blood
sample, utilizing a pair of vertically-aligned tubes coupled
together via fine tubes while using a pressure sensor to measure
the change of an internal tube pressure with the passage of time
and the change of flow rate of the blood. The Bedingham '328 patent
discloses an intravascular blood parameter sensing system that uses
a catheter and probe having a plurality of sensors (e.g., an
O.sub.2 sensor, CO.sub.2 sensor, etc.) for measuring particular
blood parameters in vivo. The Schlain '398 patent discloses a
intra-vessel method and apparatus for detecting undesirable wall
effect on blood parameter sensors and for moving such sensors to
reduce or eliminate the wall effect. The Davis '440 patent
discloses an apparatus for conducting a variety of assays that are
responsive to a change in the viscosity of a sample fluid, e.g.,
blood.
[0008] Viscosity measuring methods and devices for fluids in
general are well-known. See for example, U.S. Pat. No. 1,810,992
(Dallwitz-Wegner); U.S. Pat. No. 2,343,061 (Irany); U.S. Pat. No.
2,696,734 (Brunstrum et al.); U.S. Pat. No. 2,700,891 (Shafer);
U.S. Pat. No. 2,934,944 (Eolkin); U.S. Pat. No. 3,071,961 (Heigl et
al.); U.S. Pat. No. 3,116,630 (Piros); U.S. Pat. No. 3,137,161
(Lewis et al.); U.S. Pat. No. 3,138,950 (Welty et al.); U.S. Pat.
No. 3,277,694 (Cannon et al.); U.S. Pat. No. 3,286,511 (Harkness);
U.S. Pat. No. 3,435,665 (Tzentis); U.S. Pat. No. 3,520,179 (Reed);
U.S. Pat. No. 3,604,247 (Gramain et al.); U.S. Pat. No. 3,666,999
(Moreland, Jr. et al.); U.S. Pat. No. 3,680,362 (Geerdes et al.);
U.S. Pat. No. 3,699,804 (Gassmann et al.); U.S. Pat. No. 3,713,328
(Aritomi); U.S. Pat. No. 3,782,173 (Van Vessem et al.); U.S. Pat.
No. 3,864,962 (Stark et al.); U.S. Pat. No. 3,908,441 (Virloget);
U.S. Pat. No. 3,952,577 (Hayes et al.); U.S. Pat. No. 3,990,295
(Renovanz et al.); U.S. Pat. No. 4,149,405 (Ringrose); U.S. Pat.
No. 4,302,965 (Johnson et al.); U.S. Pat. No. 4,426,878 (Price et
al.); U.S. Pat. No. 4,432,761 (Dawe); U.S. Pat. No. 4,616,503
(Plungis et al.); U.S. Pat. No. 4,637,250 (Irvine, Jr. et al.);
U.S. Pat. No. 4,680,957 (Dodd); U.S. Pat. No. 4,680,958 (Ruelle et
al.); U.S. Pat. No. 4,750,351 (Ball); U.S. Pat. No. 4,856,322
(Langrick et al.); U.S. Pat. No. 4,899,575 (Chu et al.); U.S. Pat.
No. 5,142,899 (Park et al.); U.S. Pat. No. 5,222,497 (Ono); U.S.
Pat. No. 5,224,375 (You et al.); U.S. Pat. No. 5,257,529 (Taniguchi
et al.); U.S. Pat. No. 5,327,778 (Park); and U.S. Pat. No.
5,365,776 (Lehmann et al.).
[0009] The following U.S. patents disclose viscosity or flow
measuring devices, or liquid level detecting devices using optical
monitoring: U.S. Pat. No. 3,908,441 (Virloget); U.S. Pat. No.
5,099,698 (Kath, et. al.); U.S. Pat. No. 5,333,497. The Virloget
'441 patent discloses a device for use in viscometer that detects
the level of a liquid in a transparent tube using photodetection.
The Kath '698 patent discloses an apparatus for optically scanning
a rotameter flow gauge and determining the position of a float
therein. U.S. Pat. No. 5,333,497 (Br nd Dag A. et al.) discloses a
method and apparatus for continuous measurement of liquid flow
velocity of two risers by a charge coupled device (CCD) sensor.
[0010] U.S. Pat. No. 5,421,328 (Bedingham) discloses an
intravascular blood parameter sensing system.
[0011] A statutory invention registration, H93 (Matta et al.)
discloses an apparatus and method for measuring elongational
viscosity of a test fluid using a movie or video camera to monitor
a drop of the fluid under test.
[0012] The following publications discuss red blood cell
deformability and/or devices used for determining such: Measurement
of Human Red Blood Cell Deformability Using a Single Micropore on a
Thin Si.sub.3N.sub.4 Fil, by Ogura et al, IEEE Transactions on
Biomedical Engineering, Vol. 38, No. 8, August 1991; the Pall BPF4
High Efficiency Leukocyte Removal Blood Processing Filter System,
Pall Biomedical Products Corporation, 1993.
[0013] A device called the "Hevimet 40" has recently been
advertised at www.hevimet.freeserve.co.uk. The Hevimet 40 device is
stated to be a whole blood and plasma viscometer that tracks the
meniscus of a blood sample that falls due to gravity through a
capillary. While the Hevimet 40 device may be generally suitable
for some whole blood or blood plasma viscosity determinations, it
appears to exhibit several significant drawbacks. For example,
among other things, the Hevimet 40 device appears to require the
use of anti-coagulants. Moreover, this device relies on the
assumption that the circulatory characteristics of the blood sample
are for a period of 3 hours the same as that for the patient's
circulating blood. That assumption may not be completely valid.
Also, due to surface alteration, the device requires cleaning after
each test.
[0014] Notwithstanding the existence of the foregoing technology, a
need remains for an apparatus and method for obtaining the
viscosity of the blood of a living being in-vivo and over a range
of shears and for the provision of such data in a short time
span.
[0015] All references cited are incorporated herein by reference in
their entireties.
OBJECTS OF THE INVENTION
[0016] Accordingly, it is the general object of the present
invention to provide an apparatus and methods for meeting that
need.
[0017] It is a further object of this invention to provide
viscosity measuring apparatus and methods for determining the
viscosity of circulating blood over a range of shear rates,
especially at low shear rates.
[0018] It is still yet a further object of this invention to
provide an apparatus and methods for determining viscosity of the
circulating blood of a living being (e.g., in-vivo blood viscosity
measurement) without the need to directly measure pressure, flow
and volume.
[0019] It is yet another object of this invention to provide an
indication of the viscosity of the circulating blood of a living
being in a short span of time.
[0020] It is yet another object of this invention to provide an
indication of the effect of a bioactive agent on the viscosity of
the circulating blood of a living being.
[0021] It is yet another object of this invention to provide an
apparatus and methods for measuring the viscosity of the
circulating blood of a living being and with minimal
invasiveness.
[0022] It is still yet another object of the present invention to
provide an apparatus and methods for measuring the viscosity of the
circulating blood of a living being that does not require the use
of anti-coagulants, or other chemicals or biologically active
materials to facilitate measuring.
[0023] It is still yet another object of the present invention to
provide an apparatus and method for determining the work of the
heart of a living being based on the measured viscosity of the
circulating blood of the living being.
[0024] It is still yet another object of the present invention to
provide an apparatus and method for correlating well-known risk
factors to a living being by using the viscosity of the circulating
blood of the living being over a range of shear rates.
[0025] It is still yet another object of the present invention to
provide an apparatus and method for detecting the rate of ejection
of blood from the heart of a living being based on the pressure
pulse of the heart.
[0026] It is still yet another object of the present invention to
provide a method for explaining the cause of endothelial cell
dysfunction of a living being based on hemodynamics.
[0027] It is still yet another object of the present invention to
provide an apparatus and method for reducing endothelial cell
dysfunction in a living being which is caused by oscillating flow
of the circulating blood of the living being.
[0028] It is still yet another object of the present invention to
provide an apparatus and methods for determining the hematocrit of
the circulating blood of a living being.
[0029] It is still yet another object of the present invention to
provide an apparatus and method for determining the plasma
viscosity of the circulating blood of a living being.
[0030] It is still yet another object of the present invention to
provide an apparatus and method for providing high and low blood
vessel wall shear stress data.
[0031] It is another object of this invention to provide an
apparatus and methods for a correlation table that correlates a
blood viscosity parameter with a blood pressure parameter to a
physician with indicators of high and low blood vessel wall shear
stress data.
[0032] It is still yet another object of the present invention to
provide an apparatus and method for determining the lubricity of
the blood of a living being.
[0033] It is still yet even another object of the present invention
to provide an apparatus and method for detecting the surface
tension of the circulating blood of a living being.
[0034] It is still yet another object of the present invention to
provide an apparatus and method for improving blood perfusion in
the lower extremities of a living being.
[0035] It is still yet another object of the present invention to
provide an apparatus and methods for treating low shear injury
through the use of a surface tension analysis means.
[0036] It is still yet another object of the present invention to
provide apparatus and method for reducing the work of the
heart.
[0037] It is moreover another object of the present invention to
provide an apparatus and methods for reducing the viscosity of the
circulating blood of a living being.
[0038] It is even yet another object of this invention to provide
an apparatus and methods for determining the coagulation/clotting
effects of blood.
[0039] It is still yet another object of this invention to provide
an apparatus and methods for developing and testing drugs that
alter a living being's blood viscosity to achieve Newtonian-type
performance at high shear rates.
[0040] It is even yet another object of this invention to provide
an apparatus and methods for examining the spread of different
blood viscosity profiles over a range of shear rates of a living
being for diagnostic and treatment purposes.
[0041] It is still further another object of this invention to
provide prophylactic and therapeutic compositions for controlling
at least one property of blood measured by the apparatus and
methods of the invention.
[0042] It is still further another object of this invention to
provide a method for administering a medication to a living being
guided by blood parameter information provided by measurement
methods and apparatuses of the invention.
[0043] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate blood
viscosity, said composition comprising at least two agents selected
from the group consisting of intravenous diluents, red blood cell
deformability agents, antiurea agents, oral contraceptives,
anti-diabetic agents, antiarrythmics, antihypertensives,
antihyperlipidemics, antiplatelet agents, appetite suppressants,
antiobesity agents, blood modifiers, smoking deterrent agents,
nutritional supplements, endocrine agents, gastrointestinal agents,
anti-neoplastic agents, CNS agents, anti-infective agents,
anti-asthmatic and pulmonary agents, opthalmic agents, chelating
agents and granulocyte colony stimulating factors.
[0044] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate plasma
viscosity, said composition comprising at least two agents selected
from the group consisting of anti-diabetics, intravenous solutions,
cholesterol-lowering agents, triglyceride-lowering agents,
lubricants, homocysteine-reducing agents, and vitamin
supplements.
[0045] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate the
work of the heart, said composition comprising at least two agents
selected from the group consisting of beta-blockers, calcium
channel blockers, ACE inhibitors, ACE-II inhibitors, vasodilators,
blood pressure reducing agents, viscosity reducing agents and
anti-diabetic agents.
[0046] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate low
shear stress, said composition comprising at least two agents
selected from the group consisting of beta blockers, calcium
channel blockers, ACE inhibitors, ACE-II inhibitors, vasodilators,
blood pressure reducing agents, viscosity reducing agents,
contractility reducing agents, anti-diabetics, and anti-obesity
agents.
[0047] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate high
shear stress, said composition comprising at least two agents
selected from the group consisting of intravenous solutions,
anti-diabetics, hemodilution agents, anti-platelet agents,
lubricity enhancing agents and adhesiveness minimizing agents.
[0048] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate the
contractility of the heart, said composition comprising at least
two agents selected from the group consisting of beta-blockers,
calcium channel blockers, and peripheral
antiadrenergic/sympatholytics.
[0049] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate the
thrombogenicity of the heart, said composition comprising at least
two agents selected from the group consisting of anti-thrombogenic
agents.
[0050] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate
platelet aggregation, said composition comprising at least two
agents selected from the group consisting of warfarin, heparin, and
anti-platelet agents.
[0051] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate
lubricity, said composition comprising at least two agents selected
from the group consisting of intravenous fluids, lubricants,
anti-adhesives, surfactants, and saponifying agents.
[0052] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate
thixotropy, said composition comprising at least two agents
selected from the group consisting of sodium bentonite magma,
colloidal clays, colloidal silicon dioxide, and microcrystalline
cellulose.
[0053] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate yield
stress, said composition comprising at least two agents selected
from the group consisting of gels of colloidal clays, such as
sodium bentonite, gels of organic polymers, such as gelatin, agar,
pectin, methylcellulose, and high-molecular-weight polyethylene
glycol.
[0054] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate
endothelial shear injury, said composition comprising at least two
agents selected from the group consisting of beta-blockers and
viscosity reducing agents.
[0055] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate
coagulability, said composition comprising at least two agents
selected from the group consisting of anti-thrombogenics,
anti-platelets, heparin, and anti-coagulants.
[0056] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate
coagulation time, said composition comprising at least two agents
selected from the group consisting of anti-thrombogenics and
anti-platelets, heparin, and anti-coagulants.
[0057] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate
agglutination, said composition comprising at least two agents
selected from the group consisting of anti-platelets and
anti-coagulants.
[0058] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate clot
retraction, said composition comprising at least two agents
selected from the group consisting of anti-thrombogenics and
anti-platelets, and anti-coagulants.
[0059] It is still yet another object of the present invention to
provide a composition pharmaceutically effective to regulate clot
lysis time, said composition comprising at least two agents
selected from the group consisting of anti-thrombogenics,
anti-platelets, and anti-coagulants.
[0060] It is still further another object of the present invention
to provide a composition pharmaceutically effective to regulate
prothrombin rates, said composition comprising at least two agents
selected from the group consisting of heparin, warfarin and
anti-coagulants.
[0061] It is still further another object of the present invention
to provide a method for adjusting the distribution of a substance
through a bloodstream of an organism by altering at least one blood
flow parameter of the bloodstream.
[0062] It is still further another object of the present invention
to provide agents for adjusting the distribution of a substance
through a bloodstream of an organism by altering at least one blood
flow parameter of the bloodstream, and also to provide compositions
comprising such agents and substances.
SUMMARY OF THE INVENTION
[0063] These and other objects of the present invention are
achieved by providing a method for distributing a substance through
a bloodstream of an organism, said method comprising:
[0064] monitoring at least one blood flow parameter of said
bloodstream, said at least one blood flow parameter being selected
from the group consisting of circulating blood viscosity, absolute
viscosity, effective viscosity, low shear viscosity, high shear
viscosity, shear rate of circulating blood, work of heart,
contractility of heart, thrombogenicity, platelet aggregation,
lubricity, red blood cell deformability, thixotropy, to yield
stress, coagulability, coagulation time, agglutination, clot
retraction, clot lysis time, sedimentation rate and prothrombin
rate;
[0065] administering said substance to said organism such that an
amount of said substance enters said bloodstream; and
[0066] distributing at least a portion of said amount of said
substance to at least one target within said organism,
[0067] wherein a distribution parameter of said distributing is
adjusted by altering said at least one blood flow parameter.
[0068] These and other objects of the present invention are
achieved by providing a composition for administration to an
organism having a circulatory system, said composition
comprising:
[0069] a pharmaceutically active agent; and
[0070] a distribution agent effective to increase or decrease
distribution of said pharmaceutically active agent through said
circulatory system by increasing or decreasing at least one blood
flow parameter selected from the group consisting of circulating
blood viscosity, absolute viscosity, effective viscosity, low shear
viscosity, high shear viscosity, shear rate of circulating blood,
work of heart, contractility of heart, thrombogenicity, platelet
aggregation, lubricity, red blood cell deformability, thixotropy,
yield stress, coagulability, coagulation time, agglutination, clot
retraction, clot lysis time, sedimentation rate and prothrombin
rate,
[0071] wherein said distribution agent is not a diluent.
[0072] These and other objects of the present invention are
achieved by providing a method for determining the work of the
heart of a living being based upon the viscosity of the circulating
blood of the living being.
[0073] These and other objects of the present invention are also
achieved by providing a method for determining the rate of ejection
of blood from the heart of a living being based on the pressure
pulse of the heart.
[0074] These and other objects of the present invention are also
achieved by providing a method for reducing endothelial cell
dysfunction in a living being which is caused by oscillating flow
of the circulating blood of the living being. The method comprises
the step of reducing the rate of ejection of the blood from the
heart of the living being.
[0075] These and other objects of the present invention are also
achieved by a method for reducing endothelial cell dysfunction in a
living being which is caused by oscillating flow of the circulating
blood of the living being. The method comprises the step of
reducing the viscosity of the circulating blood of the living
being.
[0076] These and other objects of the present invention are also
achieved by a method for reducing endothelial cell dysfunction in a
living being which is caused by oscillating flow of the circulating
blood of the living being. The method comprises the steps of
reducing the rate of ejection of the blood from the heart and
reducing the viscosity of the circulating blood of the living
being.
[0077] These and other objects of the present invention are also
achieved by a method for controlling hypertension in a living
being. The method comprises the step of administering the
combination of .beta.-blocker, ACE inhibitor and blood viscosity
reducing drugs together to a living being experiencing
hypertension.
[0078] These and other objects of the present invention are also
achieved by a method for reducing blood viscosity in a living
being. The method comprises the step of administering a blood
viscosity reducing drug, including but not limited to intravenous
diluents, red blood cell deformability agents, antiurea agents,
oral contraceptives, anti-diabetic agents, antiarrythmics,
antihypertensives, antihyperlipidemics, antiplatelet agents,
appetite suppressants, anti-obesity agents, blood modifiers,
smoking deterrent agents, nutritional supplements, endocrine
agents, gastrointestinal agents, anti-neoplastic agents, CNS
agents, anti-infective agents, anti-asthmatic and pulmonary agents,
opthalmic agents, chelating agents and granulocyte colony
stimulating factors, and any derivatives and/or combinations
thereof to a living being.
[0079] These and other objects of the present invention are also
achieved by an apparatus for determining the hematocrit of the
circulating blood of a living being without having to separate red
blood cells from the plasma of the circulating blood and wherein
the apparatus comprises an optical analysis means.
[0080] These and other objects of the present invention are also
achieved by an apparatus for determining the viscosity of the
plasma of the circulating blood of a living being without the need
to centrifuge a portion of the circulating blood of the living
being and utilizing single shear rate analysis means.
[0081] These and other objects of the present invention are also
achieved by a method for estimating blood vessel wall shear stress
in high and low shear areas of a blood vessel bifurcation of a
living being by correlating a blood viscosity parameter with a
blood pressure parameter.
[0082] These and other objects of the present invention are also
achieved by a method for analyzing the viscosity of the circulating
blood of a living being. The method comprises the steps of: (a)
determining viscosity data of the living being's circulating blood
for a plurality of shear rates over a test run time; (b) segmenting
the test run time into a plurality of time segments; and (c)
generating a blood viscosity profile for each of the time segments
from the beginning of the test run until the end of each of the
time segments.
[0083] These and other objects of the present invention are also
achieved by an apparatus for automatically determining the surface
tension of the circulating blood of a living being. The apparatus
comprises a blood column height determinator based on capillary
rise.
[0084] These and other objects of the present invention are also
achieved by a method for determining whether a drug reduces or
increases the surface tension of the circulating blood of a living
being. The method comprising the steps of: (a) determining the
surface tension of the circulating blood of a living being
utilizing a blood column height determinator based on capillary
rise; (b) administering a drug to the living being; and (c)
re-determining the surface tension of the circulating blood of the
living being utilizing the blood column height determinator to see
the change in the surface tension.
[0085] These and other objects of the present invention are also
achieved by a method for improving blood perfusion to the lower
extremities of a living being experiencing peripheral arterial
disease. The method comprises the steps of: (a) determining the
viscosity of the circulating blood of the living being over a range
of shear rates; (b) reducing the viscosity of the circulating blood
by administering a substance to the living being or by blood
letting; and (c) re-determining the viscosity of the circulating
blood of the living being over the range of shear rates to verify
the reduction in the viscosity.
[0086] These and other objects of the present invention are also
achieved by providing an apparatus for determining the
deformability of red blood cells of the circulating blood of a
living being. The apparatus comprises a plurality of tubes closely
adjacent one another and each having an inner diameter different
from its neighbor. Furthermore, each of the plurality of tubes has
an opening exposed to a flow of circulating blood and each of the
tubes being closed at its other end for collecting red blood cells
therein.
[0087] These and other objects of the present invention are also
achieved by an apparatus for detecting the lubricity of the
circulating blood of a living being as the blood travels through
the vascular system of the living being. The apparatus comprises: a
transparent tube for passing a falling column of the circulating
blood of the living being; an illuminator for directing light at a
portion of the transparent tube that contains a residue left by the
falling column; a detector for detecting any light that passes
through the transparent tube and residue and generating
corresponding detection data; and calculation means for receiving
the detection data and generating a lubricity value based on the
detection data.
[0088] These and other objects of the present invention are also
achieved by prophylactic and therapeutic compositions and methods
for controlling at least one property of blood measured by the
apparatus and methods of the invention.
[0089] These and other objects of the present invention are also
achieved by a method for administering a medication to a living
being, said method comprising: (a) providing an apparatus according
to the invention, which is adapted to measure at least one blood
flow parameter of the living being selected from the group
consisting of circulating blood viscosity, absolute viscosity,
effective viscosity, low shear viscosity, high shear viscosity,
shear rate of circulating blood, work of heart, contractility of
heart, thrombogenicity, platelet aggregation, lubricity, red blood
cell deformability, thixotropy, yield stress, coagulability,
coagulation time, agglutination, clot retraction, clot lysis time,
sedimentation rate and prothrombin rate; (b) supplying a sample of
the living being's blood to the at least one apparatus; and (c)
measuring the at least one blood flow parameter to determine
whether and how to administer the medication to the living being,
wherein the apparatus is at least one member selected from the
group consisting of a circulating blood viscometer, an electronic
hematocrit analyzer, a plasma viscosity analyzer, a blood lubricity
detector, a red blood cell deformability analyzer and a surface
tension analyzer.
DESCRIPTION OF THE DRAWINGS
[0090] Other objects and many of the intended advantages of this
invention will be readily appreciated when the same becomes better
understood by reference to the following detailed description when
considered in connection with the accompanying drawings
wherein:
[0091] FIG. 1 is a block diagram of a dual riser/single capillary
(DRSC) viscometer;
[0092] FIG. 1A is a functional diagram of the first embodiment of
the DRSC viscometer during the viscosity test run;
[0093] FIG. 2 is a block diagram of another DRSC viscometer;
[0094] FIG. 2A is a functional diagram of the second embodiment of
the DRSC viscometer during the viscosity test run;
[0095] FIG. 3A is the graphical depiction of the cardiac output of
the heart of a living being;
[0096] FIG. 3B is a graphical depiction of the pressure pulse of
the heart of a living being;
[0097] FIG. 3C is a blood viscosity vs. time plot for a living
being;
[0098] FIG. 3D is a graphical depiction of the pressure pulse of
the heart of a living being having a first contractility, and
another pressure pulse of the heart having a second increased
contractility;
[0099] FIG. 3E is a graphical depiction of how the contractility of
the heart of a living being can be determined from the pressure
pulse curve;
[0100] FIG. 4 is a flow diagram of a portion of an artery showing a
bifurcation;
[0101] FIG. 5A is an enlarged view of healthy, normal endothelial
cells located along a portion of an arterial wall;
[0102] FIG. 5B is an enlarged view of dysfunctional endothelial
cells, e.g., endothelial cells located along a portion of an
arterial wall opposite a bifurcation;
[0103] FIG. 6 is a functional diagram of a hematocrit analyzer of
the present invention;
[0104] FIG. 7 is an enlarged view of a portion of the hematocrit
analyzer showing a predetermined window used in the hematocrit
analysis;
[0105] FIG. 8 is an alternative lumen for use in the hematocrit
analyzer;
[0106] FIGS. 9A-9C together constitute the plasma viscosity
analyzer;
[0107] FIG. 10 depicts a graphical representation of the respective
columns of fluid in the riser tubes of either the first or second
embodiment of the DRSC viscometer during the viscosity test
run;
[0108] FIG. 11 depicts a graphical representation of the absolute
viscosity profile versus the effective viscosity profile
corresponding to FIG. 10;
[0109] FIG. 12A depicts a typical graphical representation of the
absolute viscosity profile versus the effective viscosity profile
for a living being;
[0110] FIG. 12B depicts a graphical representation of the absolute
viscosity profile versus the effective viscosity profile for a
healthy living being;
[0111] FIG. 12C depicts a graphical representation of the effective
viscosity profile for a living being under test versus the
effective viscosity profile of a normal, healthy individual;
[0112] FIG. 13 is a table for presenting blood pressure and blood
viscosity parameters in a matrix fashion for indicating both high
and low blood vessel wall shear stress data;
[0113] FIG. 14A is an enlarged view of the top of the riser having
a falling blood column showing a meniscus;
[0114] FIG. 14B depicts a blood lubricity detector used in
conjunction with the riser tube of FIG. 14A;
[0115] FIG. 14C depicts blood lubricity plots for several living
beings under test;
[0116] FIG. 15 depicts a red blood cell deformability analyzer;
[0117] FIGS. 16A-16B depict a surface tension analyzer;
[0118] FIG. 17 depicts a graphical representation of the respective
columns of fluid in the riser tubes of either the first or second
embodiment of the DRSC viscometer during the viscosity test run
wherein the height vs. time data is segmented into a plurality of
shear rate regions;
[0119] FIGS. 18A and 18B are blood viscosity profiles for a patient
A and a patient B, respectively, based on the various shear rate
regions depicted in FIG. 17;
[0120] FIG. 19 depicts one full blood viscosity profile including
the extreme high and low shear rate ranges;
[0121] FIG. 20 depicts a method for improving blood profusion in
the lower extremities of a living being;
[0122] FIG. 21 depicts a method for treating low shear injury
through the use of a surface tension analyzer; and
[0123] FIG. 22 depicts red blood cell bonding at both a high shear
and low shear conditions.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0124] As stated previously, the present application is a
Continuation-in-Part of a co-pending U.S. patent application Ser.
No. 09/628,401, filed Aug. 1, 2000, entitled APPARATUS &
METHODS FOR COMPREHENSIVE BLOOD ANALYSIS, INCLUDING WORK OF, AND
CONTRACTILITY OF, HEART, AND THERAPEUTIC APPLICATIONS AND
COMPOSITIONS THEREOF, which in turn is a Continuation-in-Part of
Co-Pending Application Ser. No. 09/501,856, filed Feb. 10, 2000,
entitled METHOD OF ANALYZING DATA FROM A CIRCULATING BLOOD
VISCOMETER FOR DETERMINING ABSOLUTE AND EFFECTIVE BLOOD VISCOSITY,
which in turn is a Continuation-in-Part of Co-Pending Application
Ser. No. 09/439,795, filed Nov. 12, 1999, entitled DUAL
RISER/SINGLE CAPILLARY VISCOMETER, both of which are assigned to
the same Assignee as the present invention and whose entire
disclosures are incorporated by reference herein. The apparatus
disclosed in application Ser. No. 09/439,795 provides the medical
community the ability to observe the instantaneous circulating
blood viscosity characteristic that has, up until now, not been
detectable by conventional blood viscometers.
[0125] In particular, the apparatus disclosed in application Ser.
No. 09/439,795 comprises a first embodiment of a dual riser/single
capillary (DRSC) viscometer shown in FIGS. 1 and 1A, and a second
embodiment of the DRSC viscometer shown in FIGS. 2 and 2A, each of
which measures the viscosity of circulating blood, including whole
blood, of a living being. For purposes of the present invention,
either embodiment can be used to achieve the method described
herein.
[0126] Basically, the DRSC viscometers 20 (FIG. 1) and 120 (FIG. 2)
comprise a blood receiving means 22 and 122, respectively, and an
analyzer/output portion 24. The patient is coupled to the DRSC
viscometers 20/120 through a circulating blood conveying means 26,
e.g., a needle, an IV needle, an in-dwelling catheter, etc., or any
equivalent structure that can convey circulating blood from a
patient to the DRSC viscometers 20/120. The analyzer/output portion
24 includes a microprocessor 58 that, among other things,
calculates the circulating blood viscosity based on the information
that it receives from the blood receiving means 22/122. A display
28 is also provided for presenting the viscosity information, as
well as other information to the operator. The analyzer/output
portion 24 may also provide this information to other suitable
output means 30, such as a datalogger 32, other computer(s) 34, a
printer 36, a plotter 38, remote computers/storage 40, to the
Internet 42 or to other on-line services 44.
[0127] The blood receiving means 22/122 basically comprises a valve
mechanism 46 coupled between a first riser tube R1 and a second
riser tube R2 (FIGS. 1-2), or coupled to one end of one of the
riser tubes (FIGS. 3-4), for controlling the input circulating
blood flow into the DRSC viscometers 20/120. In addition, a
capillary tube 52 of known dimensions is coupled to one of the
riser tubes (e.g., as shown in FIG. 2), or is coupled between the
riser tubes (e.g., as shown in FIG. 4). In general, the valve
mechanism 46 in both embodiments establishes a first initial
position, h.sub.1, of a column of blood (h.sub.1) in one of the
riser tubes (e.g., R1) and a second initial position, h.sub.2, of
another column of blood (h.sub.2) in the other of the riser tubes
(e.g., R2). The valve mechanism 46 then isolates these columns of
blood from the input circulating blood flow, resulting in the
oppositely-moving columns of blood away from their initial
positions as shown in FIGS. 1A and 2A. Just prior to this isolation
and during the movement of the columns of blood, each column of
blood is monitored by a respective column level detector 54 and 56
which send their data to the microprocessor 58. As a result, the
column level detectors 54/56 collect data (h.sub.1(t) and
h.sub.2(t)) regarding the movement of these respective columns of
blood, which can also be plotted (FIG. 10) and then displayed on
the display screen 28.
[0128] It should be understood that it is within the broadest scope
of the invention to replace one of the two column level detectors
54/56 with a single point detector in either of the two viscometers
20 and 120 (FIGS. 1/1A and FIGS. 2/2A) as disclosed in application
Ser. No. 09/573,267, filed on May 18, 2000, entitled DUAL
RISER/SINGLE CAPILLARY VISCOMETER and whose entire disclosure is
incorporated by reference herein. This modification is based on the
symmetry of the column of blood height (i.e., h.sub.1(t) and
h.sub.2(t)) vs. time data (see FIG. 10). As long as one of the two
columns of blood 82/84 is monitored, the height vs. time data for
the other column of blood can be generated by using a single height
point from that column. In the invention of the present
application, it is only necessary to monitor the change in position
of one of the columns of blood in either riser tube R1 or riser
tube R2 and to detect only one point from the other column of
blood. The preferred method/means is to monitor the rising column
of blood 84 which occurs in riser tube R2 and to detect the initial
viscosity test run level (i.e., h.sub.1, as discussed in
application Ser. No. 09/439,795) of the column of blood 82 in riser
tube R1. Thus, it is within the broadest scope of this invention to
cover a monitor that monitors either one of the moving columns of
blood (which also includes methodologies known in the art such as
monitoring the change in position, column height, weight, volume,
mass, etc.) but not both columns (as is disclosed in application
Ser. No. 091439,795) and a single point detector for detecting one
point from the other moving column of blood.
[0129] Where both column level detectors 54/56 are used, or just
one column level detector is used, a blood column movement
indicator is also provided. This indicator provides either a visual
and/or audible indication of the blood column movement. For
example, as either the falling column moves downward or the rising
column moves upward, the indicator provides a flashing light whose
flash rate is proportional to the speed of either the falling or
rising column movement. Alternatively, or in addition, the
indicator provides a continuous beeping sound whose beeping rate is
proportional to the speed of either the falling or rising column.
As a result, when the viscosity test run begins, and the falling
and rising columns are moving at high rates, the indicator flashes
and/or beeps at a high rate; near the end of the viscosity test run
when the falling and rising columns are moving very slowly, the
indicator flashes very slowly and/or beeps a slow rate. One example
of the blood column movement indicator comprises including a sound
card (e.g., Sound Blaster AWE64 manufactured by Creative) and
speaker (not shown) in the display 28. As the columns of blood rise
or fall, the processor 58 activates the speaker card which causes
the speaker to emit a sound whose intensity varies with the speed
of the blood column. In addition, the graphical depiction of the
two height vs. time plots in the graphical display 61 can flash at
a rate that varies with the speed of the column movement.
[0130] Based on the above discussion, the apparatus and method of
the present invention are now discussed; the details of the other
components in the blood receiving means 22/122 depicted in FIGS.
1-2A are discussed in application Ser. No. 09/439,795 and
application Ser. No. 09/501,856 and are not repeated here. Suffice
it to say that using either one of the embodiments 20/120 the
viscosity (.mu.) of the circulating blood of the living being can
be determined as well as the absolute viscosity and effective
viscosity profiles for that living being.
[0131] As shown in FIGS. 1 and 2, several additional analyzers have
been added in tandem with the circulating blood viscosity
determination. These additional analysis means basically take
advantage of the single intubation of the living being by the
circulating blood conveying means 26. In particular, a hematocrit
analyzer 300, plasma viscosity analyzer 400, surface tension
analyzer 500, and red blood cell deformability analyzer 600. The
details of each of these will be discussed in below. Furthermore,
to avoid overflowing these analyzers 300-600 with circulating
blood, a valve 700 is used which permits a predetermined amount of
blood to enter the respective analyzer and then closes off the path
to these means.
[0132] Because the viscosity .mu.(t) of the circulating blood of
the living being can be determined (as set forth in application
Ser. No. 09/439,795 and application Ser. No. 09/501,856) as well as
the absolute viscosity and effective viscosity profiles (as set
forth in application Ser. No. 09/501,856) for that living being,
certain parameters of the heart can also now be determined: work of
the heart (WOH) and contractility of the heart (CON).
[0133] WOH can be estimated from the following equation: 1 ( WOH )
= 1 T 0 T P ( t ) Q ( t ) t
[0134] Work of the Heart
[0135] where:
[0136] P(t) is the pressure pulse curve of the heart (FIG. 3B);
[0137] Q(t) is the cardiac output (see FIG. 3A); and
[0138] T represents the period of one cardiac cycle.
[0139] In any flow system, the flow resistance comes from the
piping arrangement and the type of fluids. As blood viscosity
increases, the flow rate (i.e., cardiac output) decreases if the
size of pump remains constant. In a steady state flow, the
Poiseuille flow describes the flow rate (Q) in terms of the
viscosity (.mu.) of the fluid, the length (L) of the tube, the
inside diameter (d) of the tube and the pressure drop (.DELTA.P)
across the length of the tube, and is given as: 2 Q = d 4 P 128
L
[0140] The pumping power to generate Q can be given as pumping
power=Q.multidot..DELTA.P.
[0141] For a pulsatile blood flow, the WOH is given as: 3 1 T 0 T P
( t ) Q ( t ) t
[0142] where, for any given instantaneous flow, 4 Q ( t ) = d 4 P (
t ) 128 L
[0143] As used in the present context with regard to a living
being's vascular system, the term .DELTA.P(t) represents the
pressure difference between the ends of a blood vessel of a fixed
diameter and length. The vascular system between the heart (aorta)
and vein is composed of blood vessels having different diameters
and corresponding lengths which are known in the art. Since the
pressure at the capillary bed can be approximated to be zero, the
term, .DELTA.P(t), can be approximated with the pressure pulse
term, P(t), such that the equation for WOH is defined as: 5 WOH = 1
T d 4 128 L 0 T P ( t ) [ P ( t ) ( t ) ] t = d 4 128 TL 0 T P 2 (
t ) ( t ) t
[0144] where "d" and "L" represent average diameter and length of
the entire vascular system of a living being. The pressure pulse of
the heart, P(t), can be detected by conventional medical equipment
using, e.g., skin sensors and a digital storage oscilloscope. Thus,
because the viscosity .mu.(t) of the circulating blood of a living
being can be determined (FIG. 3C) using the viscometers 20/120, it
is now possible to determine the WOH of the living being.
[0145] The contractility of the heart (COH) is the rate of ejection
of blood by the left ventricle of the heart (FIG. 3D). The faster
the heart squeezes blood out of the left ventricle, the greater is
the contractility of the heart. In particular, as the contractility
of the heart increases (from the dotted line 250 which indicates a
first lower COH to the solid line 252 which indicates a second
higher COH in the direction of the arrow 254), the pressure pulse
wave becomes steeper during systole. Another term for COH is the
"pulsatility" of the heart.
[0146] Quantitatively, the contractility can be measured from the
pressure pulse curve (FIG. 3E). The slope of the pressure pulse
curve in the beginning of systole represents how fast the left
ventricle of the heart ejects blood. Hence, the slope represents
the contractility of the heart. Mathematically, 6 COH = slope = ( p
t ) @ t = 0
[0147] The importance of COH is discussed next with respect to
blood viscosity and blood vessel wall shear stress.
[0148] Arterial disease often occurs at bifurcations (FIG. 4), but
not in straight vessels. Hence, it is often called site-specific
disease. In particular, it is known that blood flow recirculation
occurs on the wall 256 opposite the flow divider 255 but has
heretofore not been explained. One of the reasons may be
hemodynamics.
[0149] In a bifurcation (FIG. 4), there is a flow 258 to the branch
vessel 260. Thus, because the mass in the main vessel 262
decreases, the pressure at location LC2 increases compared to the
pressure at location LC1, resulting in P.sub.LC2>P.sub.LC1,
where "P" stands for pressure. This pressure differential forces
some fluid elements to move upstream, producing a recirculation
flow. A recirculation flow in an unsteady, pulsatile blood flow
means that the wall shear stress between LC1 and LC2 is alternating
between a negative value (e.g., -5 dyne/cm.sup.2) and a positive
value (i.e., +5 dyne/cm.sup.2). This same type of pressure
differential also occurs at the proximal side 265 of the flow
divider 255. In particular, a recirculation flow in an unsteady,
pulsatile blood flow also occurs between location LC3 and location
LC4 wherein P.sub.LC4>P.sub.LC3. This pressure differential
forces some fluid elements to move upstream, producing a
recirculation flow in the branch flow 258. This means that the wall
shear stress between LC3 and LC4 is alternating between a negative
value (e.g., -5 dyne/cm.sup.2) and a positive value (i.e., +5
dyne/cm.sup.2). This alternating wall shear stress can be viewed as
a sandpaper or abrading effect. The effect of this alternating
shear on endothelial cells is very serious and the key to the
arterial disease. In particular, endothelial cells 266 (FIG. 5B)
become more rounded, forming dysfunctional endothelial cells which
expose leaky sites, whereas normal, healthy endothelial cells 264
are elongated and contiguous (FIG. 5A).
[0150] As shown in FIG. 5B, endothelial cells (hereinafter,
"E-cells") in a recirculating area become more rounded than
elongated along the flow direction. Rounded E-cells are more
permeable so that lipid and other macromolecules can move through
the endothelial cell layer from blood to arterial wall 267 via the
gaps, i.e., leaky sites 268. Hence, the E-cells do not perform
their normal function and are called dysfunctional E-cells. When
E-cells become rounded, the life of the cells become short, i.e.,
the cell turnover becomes high. When E-cells become dysfunctional,
this causes a series of biological responses, including the
production of nitric oxide (NO). In short, E-cells become
dysfunctional due to oscillating/alternating wall shear stress in
the low shear zones (1) at the wall 256 opposite the flow divider
255 and (2) at the proximal side 265 of the branch vessel 255.
[0151] By reducing the COH of the heart, one can reduce the
magnitude of the oscillating wall shear stress in low-shear zones.
It should be noted that it is not desirable to "reduce" low shear
stress. What is desirable is to reduce the +/- swing. When a living
being has a high contractility, the wall shear stress at the
opposite wall 256 may vary from -10 to +10 dyne/cm.sup.2. By
administering a drug to reduce the contractility, one can correct
the wall shear stress swinging from -3 to +3, wherein the E-cells
will be much less dysfunctional. Thus, by reducing the
contractility of the heart one can normalize the E-cell, reduce the
number of dysfunctional E-cells, reduce cell turnover, reduce leaky
sites, and reduce permeability of E-cells. The benefit of reducing
contractility is to reduce the transport of lipids and other
macromolecules across the E-cell layer, thus preventing the
initiation and progression of arterial disease or
atherosclerosis.
[0152] There are a number of drugs (such as beta-blockers) that can
reduce the contractility of the heart. Smoking is known to increase
the contractility of the heart, thus accelerating the progress of
atherosclerosis. Alcohol is well-known to relax the muscle of the
left ventricle of the heart, thus decreasing the contractility of
the heart. Caffeine (coffee) can increase the contractility of the
heart. Thus, well-known risk factors, such as those addressed
above, can be correlated to the contractility of the heart of a
living being.
[0153] There is also a relationship between blood viscosity (.mu.)
and dysfunctional E-cells. Blood viscosity affects the global
hemodynamics at arterial vessels, particularly at arterial
bifurcation 255, thus affecting E-cells. As blood viscosity
increases, the flow separation zone increases and the magnitude of
the alternating wall shear stress (i.e., the positive and negative
values) is amplified. As blood viscosity decreases, the magnitude
(or level) of the alternating wall shear stress decreases,
resulting in more healthy E-cells, i.e., less dysfunctional
E-cells. The shape of the E-cells is less round and the E-cell
turnover decreases. Hence, the reduced blood viscosity can reduce
the transport of lipids and macromolecules across the E-cell layer
(i.e., intima). Therefore, any drug compositions reducing blood
viscosity can reduce the number of dysfunctional E-cells which are
often called intimal injury at the early stage of atherosclerosis.
For example, drugs known to reduce viscosity include, but are not
limited to, intravenous diluents, red blood cell deformability
agents, antiurea agents, oral contraceptives, anti-diabetic agents,
antiarrythmics, antihypertensives, antihyperlipidemics,
antiplatelet agents, appetite suppressants, antiobesity agents,
blood modifiers, smoking deterrent agents, nutritional supplements
and any derivatives and/or combinations thereof. Preferably, oral
contraceptives, antiplatelet agents and antihyperlipidemics. More
preferable, aspirin and its derivatives and any pharmaceutical
compound combined with aspirin, oral contraceptives consisting
essentially of levonorgestrel, estrogen, progestin, estradiol,
ethinyl estradiol, ethynodiol, medroxyprogesterone, desogestrel,
cyproterone, norethindrone, gestodene, norgestrel, mestranol, or
norgestimate, including their salts, derivatives and any
combinations thereof, antihyperlipidemic agents, and abciximab
which is commercially available from Eli Lilly & Co. as the
prescription product ReoPro.RTM..
[0154] Suitable intravenous diluents include, but are not limited
to, saline, deionized water, and any derivatives and/or
combinations thereof.
[0155] Suitable antidiabetic agents include, but are not limited
to, metformin, acarbose, insulins including all salts and
crystalline forms, chlorpropamide, glipizide, glyburide,
tolazamide, glimepiride, troglitazone, proglitazone, repaglinide,
losartan potassium, candesartan cilexetil, irbesartan, mitiglinide,
trendolapril/verapamil, nateglinide, repaglinide, and any
derivatives and/or combinations thereof.
[0156] Suitable antihypertensive agents include, but are not
limited to, nifedipine, nisoldipine, nicardipine, bepridil,
isradipine, nimodipine, felodipine, amlodipine, diltiazem,
verapamil, isosorbide mononitrate, isosorbide dinitrate,
nitroglycerin, hydralazine, minoxidil, hydrochlorothiazide,
chlorothiazide, indapamide, metolazone, furosemide, bumetanide,
ethacrynic acid, torsemide, spironolactone, triamterene,
acetazolamide, mannitol, atenolol, bisoprolol, pindolol,
metoprolol, timolol, nadolol, propanolol, carvedilol, captopril,
fosinopril, benazepril, lisinopril, enalapril, quinapril, losartan,
valsartan, irbesartan, eprosartan, trandolapril, fenoldopam,
ramipril, doxazosin, milrinone, benidipine, lemakalim, fantofarone,
lemildipine, pirmenol, clentiazem, nebivolol, oxodipine,
sematilide, pranidipine, nifekalant, aranidipine, barnidipine,
lacidipine, bucindolol, azelnidipine, dofetilide, losartan
potassium, eprosartan, ibutilide, candesartan, watanidipine,
irbesartan, lercanidipine, landiolol, telmisartan, furnidipine,
valsartan, azimilide, carvedilol, CHF 1521, trandolapril/verapamil,
losartan, valsartan/hydrochlorothlazide, enalapril/nitrondipine,
sotalol, arbutamine, olmesartan, conivaptan, and any derivatives
and/or combinations thereof.
[0157] Suitable antihyperlipidemic agents include, but are not
limited to, lovastatin, atorvastatin, cerivastatin, simvastatin,
fluvastatin, cholestyramine, colestipol, clofibrate, gemfibrozil,
fenofibrate, pamaqueside, pitavastatin, and any derivatives and/or
combinations thereof.
[0158] Suitable appetite suppressants and anti-obesity agents
include, but are not limited to, phentermine, phendimetrazine,
sibutramine, orlistat and any derivatives and/or combinations
thereof.
[0159] Suitable blood modifiers include, but are not limited to,
aspirin, warfarin, enoxaparin, heparin, low molecular weight
heparin, cilostazol, clopidogrel, ticlopidine, tirofiban,
abciximab, dipyridamole, plasma protein fraction, human albumin,
low molecular weight dextran, hetastarch, reteplase, alteplase,
streptokinase, urokinase, dalteparin, filgrastin, immunoglogulin,
ginkolide B, clopidogrel, hirudins, foropafant, rocepafant,
bivalirudin, dermatan sulfate mediolanum, eptilibatide, tirofiban,
thrombomodulin, abcxmab, low molecular weight dermatan
sulfate-opocrin, eptacog alfa, argatroban, fondaparinux sodium,
tifacogin, lepirudin, desirudin, OP2000, melagatran, roxifiban,
parnaparin sodium, human hemoglobin (Hemosol), bovine hemoglobin
(Biopure), human hemoglobin (Northfield), antithrombin III, RSR13,
heparin-oral (Emisphere)transgenicantithrombin III, H37695,
enoxaparin sodium, mesoglycan, CTC111, bivalirudin, and any
derivatives and/or combinations thereof.
[0160] Suitable smoking deterrent agents include, but are not
limited to, nicotine, buprorion, fasudil, ziconotide, RSR13, and
any derivatives and/or combinations thereof.
[0161] Suitable nutritional supplements include, but are not
limited to, amino acid preparations, minerals, electrolytes,
vitamins, calcitriol, and any derivatives and/or combinations
thereof.
[0162] Suitable anti-infective agents include, but are not limited
to, ticarcillin disodium, cefixime, meropenem, cefprozil,
levofloxacin, cefpodoxime proxetil, imipenem, cefuroxime axetil,
trovafloxacin, mupirocin, stavudine, didanosine, nevirapine,
lamivudine, zidovudine, valcyclovir, ganciclovir, nefiracetam, and
any derivatives and/or combinations thereof.
[0163] Suitable central nervous system agents include, but are not
limited to, remifentanil, sevoflurane, tiagabine, topiramate,
lamotrigine, naratriptan, bromocriptine, tolcapone, oxaprozin,
diclofenac and misoprostol, nabumetone, granisetron, fasudil,
dotarizine, ziconotide, RSR13, zonisamide, BMS204352, foropatant,
oxcarbazepine, tropisetron and any derivatives and/or combinations
thereof.
[0164] Suitable anti-neoplastic agents include, but are not limited
to, irinotecan, topetecan, anastrozole, nilutamide, cladribine,
gemcitabine, letrozole, vinorelbine, epirubicin, and any
derivatives and/or combinations thereof.
[0165] Suitable endocrine agents include, but are not limited to,
raloxifene, calcitonin, somatotropin, recombinant somatropin,
tolterodine, temiverine, meluadrine tartrate, and any derivatives
and/or combinations thereof.
[0166] Suitable gastrointestinal agents include, but are not
limited to, lansoprazole, misoprostol, ropivacaine, and any
derivatives and/or combinations thereof.
[0167] Suitable anti-asthmatic and pulmonary agents include, but
are not limited to, bambuterol, israpafant, foropatant, rupatadine,
levosalbutamol, ARC68397AA, salbutamol (powder) (Chiesi & Astra
Zeneca), salbutamol (inhalation) (Astra Zeneca & Aventis),
salbutamol (oral), salbutamol (powder inhilation) (Astra Medici
& IVAX), formoterol, salmeterol/fluticasone propionate,
salmeterol MDI dose counter, salmeterol (inhilation) (GSK),
salmeterol hydrofluoroalkane, budesonide/formoterol, olopatadine,
and any derivatives and/or combinations thereof.
[0168] Suitable opthalmic agents include, but are not limited to,
levobetaxolol, levobunolol, latanoprost/timolol, ketotifen, and any
derivatives and/or combinations thereof. Suitable chelating agents
include, but are not limited to, desferoxamine, and any
derivatives, and/or combinations thereof.
[0169] Suitable granulocyte colony stimulating factors include, but
are not limited to, leukine, sargramostin, GM-CSF, and any
derivatives and/or combinations thereof.
[0170] Reduced viscosity can reduce the permeability of leaky
junctions, thus reducing intimal injury. It should be noted that
enhanced permeability of E-cells causes influx of lipids and
macromolecules. Reduced viscosity does reduce the magnitude of high
shear stress at the flow divider 255 of an arterial bifurcation
because wall shear stress is proportional to blood viscosity.
[0171] There is also a relationship between blood viscosity and
thrombosis. Thrombosis often occurs in the later stages of the
arterial disease. Blood viscosity may be indirectly related to
thrombogenesis. By reducing blood viscosity, the occurrence of
thrombosis can be reduced because reduced blood viscosity increases
flow velocity. Coagulability orthrombogenicity of blood indicates
the blood's tendency to coagulate, form thrombi, aggregate
platelets or clot. Thus, as shown in FIG. 11, by measuring both the
absolute and effective blood viscosity profiles and monitoring the
angle between the two profiles, .theta., one can quantitatively
evaluate the blood's tendency to form thrombi, as discussed in
application Ser. No. 09/501,856.
[0172] As mentioned earlier and as shown in FIGS. 1 and 2, four
additional analyzers have been introduced, namely, hematocrit
analyzer 300, plasma viscosity analyzer 400, surface tension
analyzer 500 and red blood cell deformability analyzer 600. Each of
these analyzers operate independently of the blood viscometers
20/120 but take advantage of sharing the single intubation of the
living being via circulating blood conveying means 26.
[0173] With regard to the hematocrit analyzer 300 (FIGS. 6-8),
there is a need to monitor the level (percentage) of hematocrit of
blood on a real time base. As blood is drawn out of a living being,
if one can measure or monitor the hematocrit, it can improve health
care quality, diagnostic capability and treatment.
[0174] Currently, hematocrit (which is defined as the volume
percentage of red blood cells in whole blood wherein the hematocrit
of a normal healthy individual is approximately 40% -45% ) is
measured using a small capillary tube where a small amount of blood
is filled from one end, and the end is closed by an amorphous,
dough-like material. Using a (micro) centrifuge, cells from blood
are separated from plasma and the volume of the cells is read in
terms of percentage, called hematocrit.
[0175] In contrast, the present invention implements a hematocrit
analyzer 300 which utilizes an optical non-contact method. Blood is
diverted from the circulating blood conveying means 26, through the
valve 700 and into the hematocrit analyzer 300. In particular, the
blood sample flows through a transparent capillary tube 302 of
approximately 20-50 .mu.m ID. A pulsing light 304 (e.g., a strobe
light) provides illumination and optically "freezes" the motion of
cells inside the tube 302. A red blood cell detector 305 is used to
count the red blood cells and may comprise a CCD camera microscope
306 and an image processing means 308. Multiple imaging frames,
e.g., 10 frames/second, can be captured by the CCD (charge coupled
device) camera/microscope 306 (e.g., a CCD having 300 dpi-83.mu.
pixel resolution available from ScanVision Inc. of San Jose,
Calif.) and processed through the image processor 308 which
includes image processing software (e.g., conventional CCD
acquisition software available with the ScanVision Inc. CCD
mentioned previously). The image processor 308 identifies cells and
counts the number of cells in a given window 310 (FIG. 7). The
given window has a predetermined volume. Since one can calculate
the total volume and cells from cell count, one can estimate the
volume percentage of cells, thus hematocrit. The total volume and
cell count can then be transmitted to a computer 312, or to the
microprocessor 58 (FIGS. 1 and 2) in the viscometer 20/120.
[0176] The new method utilized by the hematocrit analyzer 300 can
easily be validated by comparing the hematocrit data generated from
the analyzer 300 with those obtained from the conventional method
such as the microcentrifuge method described earlier.
[0177] FIG. 8 depicts an alternative lumen to the capillary tube
302. In particular, a rectangular glass tube or lumen 314, which is
readily available off-the-shelf, can be used and a predetermined
window 316 can be established for conducting the total volume and
cell count.
[0178] FIGS. 9A-9C depict portions of the plasma viscosity analyzer
400 which basically comprises a first vacutainer 402, an optional
high pressure source 404, a second vacutainer 406 and an automated
volume reader 408. Unlike the conventional way plasma is obtained,
e.g., utilizing a centrifuged blood sample, in the plasma viscosity
analyzer 400, a portion of the circulating blood is diverted
therein from the living being using the single intubation of the
living being via the circulating blood conveying means 26. In
particular, as can be seen from FIG. 9A circulating blood is
diverted to the plasma viscosity analyzer 400 via the valve 700. A
lumen 410 (e.g., a 21 gauge needle) releasably fits into the valve
700. The other end of the lumen 410 passes through a rubber
membrane or plug 412 in the top portion of a first vacutainer 402.
Disposed inside at the center of the vacutainer 402 is a porous
medium, e.g., a membrane filter 414, which separates the vacutainer
402 into an upper chamber 416 for collecting the circulating blood
15 therein and a lower chamber 418 that initially comprises a
vacuum.
[0179] The membrane filter 414 separates cells only, but not
fibrinogen. A filter membrane used for ultra-filtration with a pore
size of approximately 0.1 .mu.m should be suitable for this
purpose.
[0180] Once the circulating blood conveying means 26 is in fluid
communication with the plasma viscosity analyzer 400 via valve 700,
blood 15 flows into the upper chamber 416. Under the influence of
gravity and the pressure differential, the red blood cells are
separated from the plasma 17 (FIG. 9B) via the membrane filter 414,
i.e., the red blood cells remain in the upper chamber 416, with the
plasma 17 being collected in the lower chamber 418.
[0181] Furthermore, if the vacuum in the lower chamber 418 is not
sufficient to pull plasma through the membrane 414, to accelerate
this separation process, the first vacutainer 402 can be disengaged
from the valve 700 and coupled to a high pressure source 404 (FIG.
9B, e.g., compressed air). The high pressure source 404 forces the
collected blood 15 against the porous membrane 414 and thereby
separates the plasma 17 much more quickly. It is important to note
that plasma 17 is a Newtonian fluid, therefore the viscosity
thereof does not vary with shear rate. Thus, to determine the
plasma viscosity, it is only necessary to obtain one shear rate,
i.e., it is not necessary to monitor the change in height of a
column of plasma.
[0182] As shown in FIG. 9C, once the red blood cells and plasma are
separated, the first vacutainer 402 is disengaged from the valve
700 (or from the high pressure source 404, if used). A second
vacutainer 404, having graduations indicating different volume
levels, is coupled to the first vacutainer 402. In particular, a
lower rubber membrane or plug 420 of the first vacutainer 402 is
pierced by another lumen 422 (e.g., a 21 gauge needle). The other
end of the lumen 422 is disposed through a rubber membrane plug 424
of the second vacutainer 404. With the first lumen 410 is exposed
to atmosphere (i.e., zero gauge pressure) as shown in FIG. 9C, the
pressure above the plasma 17 is atmospheric pressure; furthermore,
the second vacutainer 404 comprises a predetermined vacuum level.
Because of this pressure differential (.DELTA.p) between the two
vacutainers 402/404, when the second lumen 422 punctures the
membrane/plug 420, the plasma 17 is forced down out of the first
vacutainer 402 down into the second vacutainer 404 via the lumen
422.
[0183] As mentioned earlier, since plasma is a Newtonian fluid,
plasma viscosity can be determined from a single shear rate,
according to the equation: 7 Q = d 4 P 128 P L
[0184] where
[0185] L=second lumen 422 length;
[0186] d=second lumen 422 inside diameter;
[0187] .DELTA.P=pressure difference between the two vacutainers
402/404 as shown in FIG. 9C (i.e., pressure levels are
predetermined and vary depending on the accumulated plasma amount,
thus mathematically estimated, no need to measure)
[0188] Q=flow rate, or volume/time; and
[0189] .mu..sub.p=plasma viscosity. 8 P = d 4 P 128 QL .
[0190] Thus, .mu..sub.p, is given by
[0191] By measuring the volume of plasma 17 accumulated over a
given period (e.g., 1 minute) in the second vacutainer 406 using
the predetermined/premarked lines 426 on the side wall of the
vacutainer 406 using a manual method or an automated volume reader
408, the plasma viscosity can be calculated. Alternatively, one can
measure the mass of the second vacutainer 406 over a given period
(e.g., 1 minute) from which one can estimate the plasma
viscosity.
[0192] In another aspect of this invention, it is desirable to
utilize blood pressure, the heart's pressure pulse curve, and blood
viscosity information in order to estimate wall shear stress in
high and low shear areas of a (coronary) bifurcation. As discussed
earlier with regard to FIG. 4, the circulating blood flows at the
(1) wall 256 opposite the flow divider 255 and at the (2) proximal
side 265 of the branch vessel 255 are experiencing low wall shear
stress whereas the distal side 269 of the branch vessel 255 is
experiencing high shear wall stress. In particular, the inventors
have developed a table (FIG. 13) showing both high and low wall
shear stress that is based on computational fluid dynamic (CFD)
modeling of the coronary bifurcation flow. Two parameters are used,
namely BPN (i.e., blood pressure number) and BVP (blood viscosity
parameter), which will be defined later below.
[0193] To use the wall-shear-stress table, it should be understood
that it is practically impossible to calculate oscillating wall
shear stress based on BPN and BVP data on a real time basis with
current high speed computers. Furthermore, it may not be necessary
to have complicated pulsatile flow information for ordinary
clinical diagnostics and treatments of various diseases such as
hypertension, diabetes, etc.
[0194] The table (FIG. 13) provides the high and low shear data as
soon as the BPN and BVP data become available. For example, if a
patient has a BVP III level and BPN5 level, one can read from the
table the corresponding values of high wall shear stress (high
.tau..sub.w) and low wall shear stress (low .tau..sub.w) The
objective of any drug administration and clinical treatment is to
move a patient condition from the lower right corner (i.e., the
worst Wall shear stress conditions) to the upper left corner (i.e.,
the ideal wall shear stress conditions).
[0195] The definitions of BVP and BPN are discussed next. To
understand the definition of BVP, it is necessary to discuss the
absolute viscosity profile and the effective viscosity profile in
view of FIGS. 10-12B. As disclosed in application Ser. No.
09/501,856, once the height vs. time data is collected from
changing column levels in the riser tubes R1 and R2, that data can
be segmented into a first shear rate range A (e.g., 320s.sup.-1 to
1s.sup.-1) and a second shear rate range B (e.g., 1 s.sup.-1 to
0.02s.sup.-1). It should be understood that the particular shear
rate selected to define the end of range A and the beginning of
range B, e.g., 1s.sup.-1, is by way of example only and not
limitation; thus, it is within the broadest scope of this invention
to cover any number of shear rates that define the end of range A
and the beginning of range B.
[0196] When the blood viscosity is plotted over time in a log-log
scale, the viscosity profile over the first shear rate range (A) is
called the "absolute viscosity profile" and the viscosity profile
over the first and second shear rate ranges (A+B) is called the
"effective viscosity profile" (see FIG. 11). As also disclosed in
application Ser. No. 09/501,856, the angle .theta. (FIG. 12A)
formed between the absolute viscosity profile and the effective
viscosity profile can be used as an indicator of blood parameters.
As is also discussed in application Ser. No. 09/501,856, it is
desirable to minimize the angle .theta. as shown in FIG. 12B by
providing medications, changing the living being's lifestyle, or
both, etc.
[0197] The blood viscosity parameter (BVP) is a value that is
determined from comparing the effective viscosity profile 800 of
the living being under test (UT) to the effective viscosity profile
802 of a normal healthy living being, e.g., a healthy young boy, as
shown in FIG. 12C. For a normal healthy person, BVP varies between
approximately 5-10 and is defined as: 9 BVP = ( effective absolute
- 1 ) 50 + ( 150 4 ) 2 + ( 1 8 ) 3
[0198] where:
[0199] .mu..sub.effective is the the effective viscosity profile
800 of a living being UT;
[0200] .mu..sub.absolute is the absolute viscosity profile and the
effective viscosity profile 802 of a normal healthy person, in a
log-log graph;
[0201] .mu..sub.150 is the living being UT's circulating blood
viscosity measured at .gamma.=150 s.sup.-1; and
[0202] .mu..sub.1 is the living being UT's circulating blood
viscosity measured at {dot over (.gamma.)}=1 s.sup.-1. 10 (
effective absolute - 1 ) 50
[0203] The first term
[0204] is known as the "effective/absolute 11 ( 150 4 ) 2
[0205] viscosity" term and represents blood's thrombotic tendency.
The second term 12 ( 1 8 ) 3
[0206] is known as the "high shear effect" term and the third
term
[0207] is known as the "low shear effect" term.
[0208] The denominators of the high shear effect term and the lows
hear effect term are used as references and are the viscosity
values (4 and 8 centipoise) from a healthy young boy at the shear
rates of 150 s.sup.-1 and 1 s.sup.-1, respectively (see FIG. 12C).
For diabetes, the high shear effect term can be much greater. A
weighting factor of "3" is used with the low shear effect term
because the low shear viscosity is often a direct cause of arterial
disease. Furthermore, since .mu..sub.1 for the subject is often
much greater than 8 centipoise for most adults, the low shear
effect term can be the largest contributor among the three terms. A
weighting factor of "2" is used with the high shear effect term
since the effect of high shear on atherosclerosis is less than that
of low shear viscosity.
[0209] With regard to the BPN, the BPN can be defined as an average
blood pressure term (i.e., the average value of the systole and
diastole) and a contractility of the heart (COH) term.
[0210] Once a BVP and a BPN is determined for any particular living
being, these values can be immediately referenced according to the
table shown in FIG. 13 and the high and low wall shear stress
indicated. Depending on the patient's particular BVP/BPN, the
physician and/or specialist can then devise a regimen of drugs
and/or lifestyle changes (as mentioned previously) to move the
patient's cardiovascular system toward the upper left corner of the
table in FIG. 13.
[0211] As mentioned earlier, the h.sub.1(t) and h.sub.2(t)
data/curves of the viscometers 20/120 can be segmented into two
shear rate regions (A and B) and from which an absolute viscosity
profile and an effective viscosity profile can be obtained. These
h.sub.1 (t) and h.sub.2(t) data/curves can be further segmented
into a plurality of regions (see FIG. 17), resulting in a plurality
of viscosity profiles (see FIG. 18A), and two of which are the
absolute viscosity profile (III, in FIGS. 12A and 18A) and the
effective viscosity profile (VI, in FIGS. 12A and 18A). As an
example, as shown in FIG. 17, the h.sub.1(t) and h.sub.2(t)
data/curves have been segmented into six regions.
[0212] The determination of the blood viscosity profile for each
segment is in accordance with the equations set forth in
application Ser. No. 09/501,856 and application Ser. No. 09/439,795
but wherein the data used for each region is defined as
follows:
[0213] Region I: 0<t<t.sub.1
[0214] Region II: 0<t<t.sub.2
[0215] Region III: 0<t<t.sub.3
[0216] Region IV: 0<t<t.sub.4
[0217] Region V: 0<t<t.sub.5
[0218] Region VI: 0<t<t.sub.6,
[0219] i.e., for each new region analyzed, all prior height vs.
time data is used. It should be noted that in the first region,
Region I, the blood viscosity calculated using the data
0<t<t.sub.1 is a freshly shed, high shear blood viscosity. It
is also desirable to obtain viscosity data in a shear rate
range>100s.sup.-1. It should also be noted that the blood
viscosity calculated using Region VI data contains the most
significant effect of coagulation/clotting because while the
columns of blood in riser tubes R1 and R2 fall and rise,
respectively, the blood is exposed to air. Thus, the h.sub.1(t) and
h.sub.2(t) data/curves contain information about the blood's
coagulability characteristics. This segmentation of these
data/curves and the subsequent analysis helps further define these
coagulability characteristics of the blood.
[0220] Based on the above, FIGS. 18A and 18B provide the various
blood viscosity profiles (in a log viscosity vs. log shear rate
plot) over the six regions, for two hypothetical patients: patient
A (FIG. 18A) and patient B (FIG. 18B). By examining the spread in
the blood viscosity profiles, one can make a judgment in terms of
diagnostics and treatment. For example, patient A shows almost
Newtonian type high shear viscosity (Region I viscosity profile is
substantially horizontal, i.e., the viscosity in that region does
not vary over shear rate). Thus, since it is now possible to
identify the blood viscosity profile in the high shear rate range,
it is possible to develop and test drugs that alter the living
being's blood viscosity to achieve such Newtonian-like performance
at high shear rates.
[0221] FIG. 19 confirms that the plurality of blood profiles
depicted in FIGS. 18A and 18B form the central portion of the log
viscosity vs. log shear rate plots, i.e., the extreme ends, both
extreme high shear rates and extreme low shear rates, are not
plotted or used.
[0222] The surface tension analyzer 500 (FIGS. 16A-16B) provides a
measurement of the surface tension of a liquid; in the preferred
embodiment blood is the liquid whose surface tension is being
determined. Typically, surface tension is measured using a
bubble-blowing method; however, this method is labor-intensive and
a time-consuming procedure. When liquid becomes hazardous to
handle, e.g., human blood, it is desirable to have a fully
automated procedure.
[0223] In general, where the surface tension of a liquid is being
determined using a cylindrical capillary tube, the surface tension
is defined as that upward vertical force which balances the weight
of the liquid element. In most liquid/solid interfaces, a contact
angle, .delta., is formed between the liquid and the capillary
tube, such as that depicted in FIG. 14A. However, where the liquid
whose surface tension is being determined is water or blood, the
contact angle .delta.=0.degree. and therefore the vertical
component of surface tension, namely, .pi.d.sigma. cos .delta.
which counteracts the weight of the liquid, is simply .pi.d.sigma..
Thus, the surface tension, .sigma., is calculated based on the
following: 13 d = ( d 2 4 h ) g , = dhg 4
[0224] where
[0225] .sigma.=surface tension (N/m)
[0226] d=capillary tube inside diameter (m); and
[0227] h=the height of the liquid element (m)
[0228] The surface tension analyzer 500 provides a unique manner
for accurately determining the height of the liquid element in the
surface tension analysis using capillary rise, as is discussed
below.
[0229] As shown in FIG. 16A, the surface tension analyzer 500
comprises a conduit 502 from the valve 700, a stopcock 504, a
capillary tube 506, a CCD sensor array 508, an elbow 509, a
mini-reservoir 510 and an adjacent overflow chamber 512. An
aperture 514 is provided in one of the walls of the mini-reservoir
510 adjacent the overflow chamber 512. As will be discussed below,
as the column of blood 513 flows down the capillary tube 506,
through the stopcock 504, through the elbow 509 and into the
mini-reservoir 510, the aperture 514 controls the blood level 516
in the mini-reservoir 510, i.e., as the collected blood level 516
rises to or above the aperture 514, blood flows into the overflow
chamber 512. As a result, the exact level of blood in the
mini-reservoir 510 is maintained. The CCD sensor array 508 is
positioned at a predetermined height, h.sub.r, above the aperture
514. As is discussed below, when the CCD sensor array 508 detects
the final position of the column in the capillary tube 506, the
predetermined height, h.sub.r, can be programmed into the CCD
sensor array 508 as an offset such the height necessary for the
surface tension calculation, namely, h.sub.f, is sent to the
processor 58. In the alternative, the predetermined height,
h.sub.r, can already be stored in the processor 58 and only the
final position of the column in the capillary tube 508 is detected
and transmitted by the CCD sensor array 508 to the processor 58;
the processor 58 then adds the value h.sub.r to the final position
of the column height to arrive at h.sub.f. In either case, the
processor 58 calculates the surface tension according to the above
equation.
[0230] The surface tension analyzer 500 operates as follows: Before
the test is run, the inside of the capillary tube 506 is wetted by
the blood of the living being as it flows from the valve 700. In
particular, with the stopcock valve 504 in its initial position as
shown in FIG. 16A, the blood flows upward into the capillary tube
506, whose top (not shown) is vented to atmosphere. When the CCD
sensor array 508 detects a predetermined level (not shown) of the
column of blood 513 in the capillary tube 506, the stopcock valve
504 is rotated to isolate the capillary tube 506 from the conduit
502 and to couple the tube 506 to the elbow 509 and mini-reservoir
510. As the stopcock valve 504 connects the capillary tube 506 to
the mini-reservoir 510, blood in the capillary tube 506 falls and
settles at a level, h.sub.f. The CCD sensor 508 monitors the final
position of the column 513. It should be noted that h.sub.f is the
distance between the blood level in the capillary tube 506 and the
level 516 in the mini-reservoir 510 and therefore represents the
height of the liquid element required for determining the surface
tension, .sigma., as discussed above. The aperture 514 on the side
wall of the mini-reservoir 510 controls the blood level 516 in the
reservoir 510. Blood from the reservoir 510 flows into the overflow
chamber 512 if the fluid level 516 rises above the aperture 514.
Using this level-control aperture, the exact level of blood 516 in
the mini-reservoir 510 is known.
[0231] Because surface tension, .sigma., is related to yield
stress, .tau..sub.0, (as discussed in application Ser. No.
09/501,856) which is related to RBC (red blood cell) agglomeration
(see FIG. 22 where at high shear conditions, the blood cells bonds
are evenly spaced allowing these bonds to be easily severed versus
low shear conditions where the cells are closely stacked, known as
a Rouleaux formation, and where the yield stress/RBC agglomeration
causes thrombosis), using the surface tension analyzer 500, it is
now possible to determine whether a drug reduces or increases the
surface tension of whole blood. In particular, FIG. 21 depicts a
method for treating low shear injury through the use of surface
tension analyzer 500. The determination of the surface tension of
blood can be of great assistance to pharmaceutical companies in
their quest to manufacture drugs that reduce the surface tension of
whole blood. One of the benefits of reducing the surface tension of
blood is to reduce blood viscosity and the work of the heart. For
example, saline IV solution and distilled water reduces surface
tension and blood viscosity, thus reducing the work of the heart.
In addition, blood letting can reduce the surface tension.
[0232] Another use of blood viscosity measurement is for treatment
of patients with peripheral arterial disease (PAD). Patients with
PAD often experience claudication (i.e., lower extremity pain, ache
or cramp in the calf, buttock or thigh). PAD occurs when fatty
deposits buildup in the arteries, decreasing blood supply to the
part of the upper or lower body. This could be due to the
insufficient blood flow to the lower extremities. Hence, drugs to
reduce peripheral vascular resistance (PVR) are often administered
to improve blood flow, thereby reducing pain/ache caused by
PAD.
[0233] As shown in FIG. 20, a method can be used to improve blood
perfusion to the lower extremities by reducing blood viscosity. As
mentioned earlier, the reduction of blood viscosity can be
accomplished by blood letting or the injection of distilled water
(i.e., saline IV solution) or mechanical vibration. By improving
circulation and reducing PVR, one can reduce pain while increasing
walking distance, as well as quality of life in individuals with
intermittent claudication.
[0234] Another use of the above methods and apparatus is in the
control of hypertension. Typically, there are four basic approaches
to control hypertension, each of which is administered independent
of the other:
[0235] 1) .beta.-blocker/calcium-channel blocker which slows down
the heart, thereby reducing COH;
[0236] 2) ACE inhibitor--vasodilator (which opens capillaries in
upper/lower extremities);
[0237] pure blood pressure lowering drugs;
[0238] 3) Blood viscosity reduction
[0239] blood thinner like Coumadin
[0240] Fish oil
[0241] Blood letting
[0242] Cholesterol-lowering drugs
[0243] 4) Diuretics--removes water from blood--but actually
increases blood viscosity.
[0244] In light of the above, a new method of treating hypertension
is to apply .beta.-blocker/calcium-channel blocker, ACE inhibitor
(including the vasodilator and blood pressure lowering drugs), and
blood viscosity reducing drugs in combination to effectively reduce
hypertension. The use of diuretics is not to be used with this
combination since it has just the opposite effect. Therefore, a
pharmaceutical composition combining at least three members
selected from the group consisting of .beta.-blockers,
calcium-channel blockers, ACE inhibitors (including the vasodilator
and blood pressure lowering drugs), and blood viscosity reducing
drugs, may reduce the work of the heart, control hypertension and
the overall risk of the vascular disease.
[0245] The combined use of certain pharmaceutical agents may
regulate (i.e. alter or maintain) various blood parameters. For
instance, the combination of at least two pharmaceutical agents
selected from the group consisting of intravenous diluents, red
blood cell deformability agents, antiurea agents, oral
contraceptives, anti-diabetic agents, antiarrythmics,
antihypertensives, antihyperlipidemics, antiplatelet agents,
appetite suppressants, anti-obesity agents, blood modifiers,
smoking deterrent agents, and nutritional supplements may regulate
blood viscosity.
[0246] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of anti-diabetics, intravenous
solutions, cholesterol-lowering agents, triglyceride-lowering
agents, lubricants, homocysteine-reducing agents, and vitamin
supplements may be used to regulate plasma viscosity.
[0247] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of beta-blockers, calcium
channel blockers, ACE inhibitors, ACE-II inhibitors, vasodilators,
blood pressure reducing agents, viscosity reducing agents and
anti-diabetic agents may regulate the work of the heart.
[0248] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of beta blockers, calcium
channel blockers, ACE inhibitors, ACE-II inhibitors, vasodilators,
blood pressure reducing agents, viscosity reducing agents,
contractility reducing agents, anti-diabetics, and
anti-obesityagents may regulate lowshear stress.
[0249] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of intravenous solutions,
anti-diabetics, hemodilution agents, anti-platelet agents,
lubricity enhancing agents and adhesiveness minimizing agents may
regulate high shear stress.
[0250] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of beta-blockers, calcium
channel blockers, and peripheral antiadrenergic/sympatholytics may
regulate the contractility of the heart.
[0251] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of anti-thrombogenic
agents may regulate the thrombogenicity of the heart.
[0252] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of warfarin, heparin, and
anti-platelet agents (e.g., aspirin) may regulate platelet
aggregation.
[0253] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of intravenous fluids,
lubricants, anti-adhesives, surfactants, and saponifying agents may
regulate lubricity.
[0254] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of sodium bentonite magma;
colloidal clays (such as magnesium bentonite and attapulgite),
colloidal silicon dioxide, and microcrystalline cellulose may
regulate thixotropy.
[0255] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of gels of colloidal
clays, such as sodium bentonite, gels of organic polymers, such as
gelatin, agar, pectin, methylcellulose, and high-molecular-weight
polyethylene glycol may regulate yield stress.
[0256] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of beta-blockers and viscosity
reducing agents may regulate endothelial shear injury.
[0257] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of anti-thrombogenics and
anti-platelets (e.g., aspirin), heparin, and anti-coagulants may
regulate coagulability.
[0258] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of anti-thrombogenics and
anti-platelets (e.g., aspirin), heparin, and anti-coagulants may
regulate coagulation time.
[0259] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of anti-platelets and
anti-coagulants may regulate agglutination.
[0260] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of anti-thrombogenics and
anti-platelets (e.g., aspirin), and anti-coagulants may regulate
clot retraction.
[0261] Additionally, the combination of at least two pharmaceutical
agents selected from the group consisting of anti-thrombogenics and
anti-platelets (e.g., aspirin), and anti-coagulants may regulate
clot lysis time.
[0262] Also, the combination of at least two pharmaceutical agents
selected from the group consisting of heparin, warfarin and
anti-coagulants may regulate prothrombin rates.
[0263] In addition, embodiments of the present method enable
adjusting the distribution of a substance through a bloodstream of
an organism by altering at least one blood flow parameter of the
bloodstream.
[0264] The substance being distributed is not particularly limited,
but includes, e.g., pharmaceutically active agents.
[0265] The method is suitable for use in any organism, including,
e.g., single-celled organisms, and multicellular organisms, such as
humans and other mammals.
[0266] The substance being distributed is suitably administered in
any way in which at least some (preferably about 1 wt. % to about
100 wt. %) of the substance reaches the bloodstream of the
organism. Thus, the substance can be administered enterally (via
the alimentary canal) or parenterally (via any route other than the
alimentary canal, such as, e.g., through intravenous injection,
subcutaneous injection, intramuscular injection, inhalation
percutaneous application, etc.).
[0267] Suitable targets for the substance being distributed
include, e.g., cells, tissues, organs or systems. Thus, while
distribution through the bloodstream is adjusted by this aspect of
the invention, the ultimate effects of such adjustments are not
limited to the bloodstream specifically or the circulatory system
in general. That is, the target for the substance need not be part
of the circulatory system, as long as some amount of the substance
(in certain embodiments, about 1 wt. % to about 100 wt. % of the
substance in the bloodstream) in the bloodstream reaches its
intended target.
[0268] A distribution parameter for distributing the substance is
adjusted, up and/or down, or simply maintained at a desired value,
preferably through the use of an agent such as, e.g.,
levonorgestrel, estrogen, progestin, estradiol, ethinyl estradiol,
ethynodiol, medroxyprogesterone, desogestrel, cyproterone,
norethindrone, gestodene, norgestrel, mestranol, norgestimate,
metformin, acarbose, insulin, chlorpropamide, glipizide, glyburide,
tolazamide, glimepiride, troglitazone, proglitazone, repaglinide,
losartan potassium, candesartan cilexetil, irbesartan, mitiglinide,
trendolapril/verapamil, nateglinide, nifedipine, nisoldipine,
nicardipine, bepridil, isradipine, nimodipine, felodipine,
amlodipine, diltiazem, verapamil, isosorbide mononitrate,
isosorbide dinitrate, nitroglycerin, hydralazine, minoxidil,
hydrochlorothiazide, chlorothiazide, indapamide, metolazone,
furosemide, bumetanide, ethacrynic acid, torsemide, spironolactone,
triamterene, acetazolamide, mannitol, atenolol, bisoprolol,
pindolol, metoprolol, timolol, nadolol, propanolol, carvedilol,
captopril, fosinopril, benazepril, lisinopril, enalapril,
quinapril, losartan, valsartan, eprosartan, trandolapril,
fenoldopam, ramipril, doxazosin, milrinone, benidipine, lemakalim,
fantofarone, lemildipine, pirmenol, clentiazem, nebivolol,
oxodipine, sematilide, pranidipine, nifekalant, aranidipine,
barnidipine, lacidipine, bucindolol, azelnidipine, dofetilide,
ibutilide, watanidipine, lercanidipine, landiolol, telmisartan,
furnidipine, azimilide, CHF 1521, valsartan/hydrochlorothlazide,
enalapril/nitrondipine, sotalol, arbutamine, olmesartan,
conivaptan, lovastatin, atorvastatin, cerivastatin, simvastatin,
fluvastatin, cholestyramine, colestipol, clofibrate, gemfibrozil,
fenofibrate, pamaqueside, pitavastatin, phentermine,
phendimetrazine, sibutramine, orlistat, aspirin, warfarin,
enoxaparin, heparin, low molecular weight heparin, cilostazol,
clopidogrel, ticlopidine, tirofiban, abciximab, dipyridamole,
plasma protein fraction, human albumin, low molecular weight
dextran, hetastarch, reteplase, alteplase, streptokinase,
urokinase, dalteparin, filgrastin, immunoglogulin, ginkolide B,
hirudins, foropafant, rocepafant, bivalirudin, dermatan sulfate
mediolanum, eptilibatide, thrombomodulin, low molecular weight
dermatan sulfate-opocrin, eptacog alfa, argatroban, fondaparinux
sodium, tifacogin, lepirudin, desirudin, OP2000, melagatran,
roxifiban, parnaparin sodium, human hemoglobin (Hemosol), bovine
hemoglobin (Biopure), human hemoglobin (Northfield), antithrombin
III, RSR 13, heparin-oral (Emisphere) transgenic antithrombin III,
H37695, mesoglycan, CTC111, nicotine, buprorion, fasudil,
ziconotide, amino acid preparations, minerals, electrolytes,
vitamins, calcitriol, ticarcillin disodium, cefixime, meropenem,
cefprozil, levofloxacin, cefpodoxime proxetil, imipenem, cefuroxime
axetil, trovafloxacin, mupirocin, stavudine, didanosine,
nevirapine, lamivudine, zidovudine, valcyclovir, ganciclovir,
nefiracetam, remifentanil, sevoflurane, tiagabine, topiramate,
lamotrigine, naratriptan, bromocriptine, tolcapone, oxaprozin,
diclofenac, misoprostol, nabumetone, granisetron, dotarizine,
RSR13, zonisamide, BMS204352, oxcarbazepine, tropisetron,
irinotecan, topetecan, anastrozole, nilutamide, cladribine,
gemcitabine, letrozole, vinorelbine, epirubicin, raloxifene,
calcitonin, somatotropin, recombinant somatropin, tolterodine,
temiverine, meluadrine tartrate, lansoprazole, ropivacaine,
bambuterol, israpafant, rupatadine, levosalbutamol, ARC68397AA,
salbutamol (powder), salbutamol (inhalation), salbutamol (oral),
salbutamol (powder inhilation), formoterol, salmeterol/fluticasone
propionate, salmeterol MDI dose counter, salmeterol (inhilation),
salmeterol hydrofluoroalkane, budesonide/formoterol, olopatadine,
levobetaxolol, levobunolol, latanoprost/timolol, ketotifen,
desferoxamine, leukine, sargramostin and GM-CSF.
[0269] The distribution parameter can be any such parameter used to
evaluate distribution of the substance in an organism. Suitable
parameters include, but are not limited to distribution rate and
bioavailability.
[0270] In embodiments where the distribution rate is decreased, it
is particularly preferred to hinder the distribution of a
substance, such as a psychoactive ingredient in an addictive
product. Another example of such an embodiment is comprises
hindering the distribution of toxins and other substances in
cigarettes and other tobacco products.
[0271] FIG. 15 depicts the red blood cell deformability analyzer
600. In particular, the analyzer 600 comprises a plurality of tubes
602 having various inner diameters in the range from 1 .mu.m to 10
.mu.m and with each tube 602 being in contact with its neighboring
tube 602. When circulating blood enters the analyzer 600 from the
valve 700, depending on the size of a particular red blood cell
(RBC), each RBC will either (1) enter that tube 602 which is large
enough for the RBC to pass through, or (2) enter that tube 602 for
which the RBC is able to deform without rupturing. As the RBCs
collect in various tubes 602, a light source 604 illuminates the
plurality of tubes 602. The light passing through the tubes 602
having varying degrees of "redness" is detected by a red color
detector 606 (e.g., light source 604/color detector 606 can be
implemented by the CS64A color sensor manufactured by Delta
Computer Systems, Inc. of Vancouver, WA which comprises both a
light generation system and a light receiving system for detecting
color; a digital/analog converter is used to make the output of the
CS64A compatible for computer processing). The higher degree of
redness, the higher the RBC content in the tube 602. The red color
detector 606 collects the redness information along with the
corresponding tube 602 and then passes this information to the
processor 58.
[0272] FIGS. 14A-14B depict another blood characteristic detector:
a blood lubricity detector 800.
[0273] It should be understood that although the term "lubricity"
is known by those skilled in the mechanical arts as describing the
slipperyness between two solids, the term "lubricity" as used in
this patent application refers to the "slipperyness" of the blood
flow with respect to the vessel wall, i.e., the slipperyness
between a liquid (blood) and a solid (the vessel wall).
[0274] Furthermore, it should also be understood that another
parameter of the blood is the blood's "adhesiveness" which refers
to the property of the blood which causes it to cling to the vessel
walls. The lubricity and the adhesiveness of the blood are
inversely related, namely, as adhesiveness increases the lubricity
decreases, and vice versa.
[0275] In particular, as shown in FIG. 14A, a meniscus 802 forms at
the top of the column of blood as it falls down the riser tube R1.
As the meniscus 802 falls, a thin residue of blood of varying
thickness is left on the inside surface of the riser tube R1; this
is indicated by the reference numbers 804A and 804B. As can be
seen, the residue has a minimum thickness at the higher elevations
806 of the riser tube R1 and maximum thickness closest to the
meniscus 802 itself, as indicated by the reference number 808. The
amount of this residue is indicative of the lubricity of the blood
and is exemplary of the lubricity of the blood as it travels
through the vascular system of a living being.
[0276] To measure this varying amount of film, the lubricity
detector 800 is used. The detector 800 comprises a light source 810
located on one side of the riser tube R1 near its top portion. The
detector 800 also comprises a light detector 812 located on the
opposite side of the top portion of the riser tube R1, directly
opposite the light source 810. Depending on the thickness of the
thin film layer, light rays 814 emanating from the light source
will pass through the riser tube R1 wall, a portion of the film of
blood on one side of the tube R1, the other thin layer of blood on
the opposite side of the tube R1 and through the other side of the
riser tube R1 to be detected by the light detector 812. As the
residue gets thicker, eventually the light rays 814 directed at
that portion of the residue cannot pass through and, as result, are
not detected by the detector 812.
[0277] An example of the light detector 812 is a CCD having a
vertical array of pixels (or an active-pixel sensor (APS)
comprising rows/columns of pixels). Light rays 814 that pass
through the blood residue in the riser tube R1 impact the pixels at
a certain illumination level for different height levels (x)
depending on the thickness of the blood residue. If a Gray scale is
used to designate varying degrees of illumination (e.g., 256= full
light intensity detected; 0= no light detected at all) such pixel
data is transmitted to the processor 58 which plots all of these
Gray scale values as a function of the vertical position, x. FIG.
14C depicts such plots for different living beings. The processor
58 determines the slope of each curve which is an indicator of the
lubricity of a particular living being's blood. An alternative
indicator of lubricity may comprise the sum of Gray scale values
over a specified vertical length; the higher the sum value, the
greater the lubricity since there is little or no blood residue
blocking the light rays 814. In a normal healthy living being the
lubricity should be high so that a minimum amount of residue,
having a minimum thickness, would be left on the inside of the
riser tube R1.
[0278] It should be understood that blood pressure monitors such as
the implantable blood pressure monitors disclosed in U.S. Pat. No.
6,015,386 (Kensey et al.), whose entire disclosure is incorporated
by reference herein, or any other type of blood pressure monitor,
can be used in combination with the viscometers 20/120 as shown in
FIGS. 1 and 2 to accomplish the methods described herein. For
example, the implantable blood pressure monitors of U.S. Pat. No.
6,015,386 (Kensey et al.) can be implanted in the living UT and can
be used in determining the COH and/or generating the BPN, both of
which are discussed above.
[0279] The above-described apparatuses and diagnostic methods
enable the practice of a variety of prophylactic and/or therapeutic
methods using a variety of prophylactic and/or therapeutic
compositions to control at least one property of blood measured by
the apparatus and methods of the invention.
[0280] Table 1, below, provides examples of preferred
pharmaceuticals for adjusting blood flow parameters.
1 ACTION THERAPEUTIC/PROPHYLACTIC* Decreasing Blood cholesterol
lowering agents, fish oils, Viscosity blood thinning agents,
intravenous diluents (e.g., saline, deionized water), red blood
cell deformability agents, anti-diabetics, anti-urea agents
Decreasing Plasma anti-diabetics, intravenous solutions, Viscosity
cholesterol-lowering agents, triglyceride-lowering agents,
lubricants, homocysteine-reducing agents, vitamin supplements
Decreasing Work of beta-blockers, calcium channel blockers, Heart
ACE inhibitors, ACE-II inhibitors, vasodilators, blood pressure
reducing agents, viscosity reducing agents and anti-diabetics
Decreasing Low Shear beta blockers, calcium channel blockers,
Stress ACE inhibitors, ACE-II inhibitors, vasodilators, blood
pressure reducing agents (see above), viscosity reducing agents,
contractility reducing agents, anti-diabetics, anti-obesity agents
Decreasing High Shear intravenous solutions, anti-diabetics, Stress
hemodilution agents, anti-platelet agents, lubricity enhancing
agents and adhesiveness minimizing agents. Reducing Contractility
beta-blockers; calcium channel blockers; of Heart peripheral
antiadrenergic/sympatholytics Reducing anti-thrombogenics
Thrombogenicity Reducing Platelet Warfarin, Heparin, Aspirin
Aggregation Increasing Lubricity intravenous fluids, lubricants,
anti-adhesives, surfactants, saponifying agents Altering Thixotropy
Sodium bentonite magma; colloidal clays (magnesium bentonite,
attapulgite); colloidal silicon dioxide; microcrystalline cellulose
Decreasing Yield Stress gels of colloidal clays (sodium bentonite);
gels of organic polymers (gelatin, agar, pectin, methylcellulose,
and high- molecular-weight polyethylene glycol) Reducing
Endothelial beta-blockers, viscosity reducing agents Shear Injury
(see above) Altering Coagulability anti-thrombogenics and
anti-platelets (e.g., aspirin); Heparin; anti-coagulants Altering
Coagulation anti-thrombogenics and anti-platelets Time (e.g.,
aspirin); Heparin; anti-coagulants Altering Agglutination
anti-platelets; anti-coagulants Altering Clot Retraction
anti-thrombogenics and anti-platelets (e.g., aspirin);
anti-coagulants Altering Clot Lysis Time anti-thrombogenics and
anti-platelets (e.g., aspirin); anti-coagulants Altering
Prothrombin Heparin; Warfarin; anti-coagulants Rate Controlling
Hypertension beta-blockers, calcium channel blockers, ACE
inhibitors, blood pressure reducing agent and a blood viscosity
reducing agent *The following class definitions are in accordance
with conventional definitions employed by, e.g., the 12th Edition
of the Merck Index (1996) and/or the 54th Edition of the
Physician's Desk Reference (1999) and/or the 54th Edition of the
Drug Facts and Comparisons (2000) and/or the 19th Edition of
Remington's Pharmaceutical Sciences (1995), and are intended to
encompass presently existing and subsequently discovered
pharmaceuticals listed in these classes.
[0281] Without further elaboration, the foregoing will so fully
illustrate our invention and others may, by applying current or
future knowledge, readily adapt the same for use under various
conditions of service.
* * * * *
References